Why did a host of regulators and official bodies fail to notice the appalling conditions at Stafford hospital?
Inquiry chairman Robert Francis QC found that Stafford Hospital had displayed “systemic failings” and “routinely neglected” its patients.
The independent report found Mid Staffordshire NHS Foundation Trust had lost sight of its responsibility to provide safe care after managers became preoccupied with cost-cutting and Government targets.
In 2008, the trust, which also runs Cannock Chase Hospital, had been granted Foundation status by the watchdog Monitor, after an intensive three month investigation.
The decision was made despite Stafford hospital having one of the highest mortality rates in the country. In the three-year period from 2005 to 2008, between 400 and 1,200 more people had died than would have been expected.
Peter Carter, general secretary, of the Royal College of Nursing, told Channel 4 News that the way trusts were judged on being granted Foundation status, which allows greater financial freedom from Whitehall, relied too heavily on financial results and targets.
“The Monitor process involves a heavy emphasis on financial management, ensuring trusts meet all their financial obligations and targets,” he said.
“Monitor should also give an equal weight to patient care”.
In March 2009, the Health Care Commission concluded the hospital had appalling standards of care which put patients at risk.
Chris Mellor from Monitor told Channel 4 News that its inspection regime had improved since it investigated Stafford hospital: “With hindsight, we relied too much on the information given at the time. What we have done since is strengthen our processes.”
In a statement the Care Quality Commission which has replaced the Healthcare Commission said: “The trust has made important progress since the period described in the Francis Report.
“Steps have been taken to address immediate risks to patients and the new leadership of the trust has responded positively.
“It is important to understand that the scale of change required in this organisation was very significant and was never going to happen overnight.”
Mid Staffordshire NHS Foundation Trust still has its foundation status.
Julie Bailey, who founded the ‘Cure the NHS’ campaign after her mother died at Stafford hospital in 2007, said she did not believe the problems at Stafford hospital was a local failure.
“This isn’t a local issue, this is happening throughout the NHS, particularly foundation trust hospitals, and particularly with the elderly and vulnerable.”