News yesterday of the report into the standards at Mid-Staffordshire NHS Foundation Trust: http://www.healthcarecommission.org.uk/newsandevents/mediacentre/pressreleases.cfm?cit_id=1640&FAArea1=customWidgets.content_view_1&usecache=false. Much of the media coverage seems to have decided to direct questions at politicians for the regime of targets and incentives put in place and the management responses to these incentives. Most prominently, the Trust received Foundation status recently, giving it more autonomy from central controls.
But can the series of failings be blamed on management’s drive to achieve their targets and Foundation status? To some degree, this will have been an issue. Certainly, financial constraints and 4-hour waiting times in Accident and Emergency feature as a focus of attention. But some of the standards are so unacceptable that they do not represent reasonable managerial responses to any target or pressure. What hospital would seriously decide to fail to respond to calls from patients or fail to provide trained staff to make clinical decisions? At that point, have you not ceased to be a hospital that anyone would recognise? To that degree, the failings are not the fault of the performance regime but of the management.
Some organisations do lose sight of their purpose – this is the case in the public, private and not-for-profit sectors. The Healthcare Commission suggests that Trust Board meetings in this instance focused on finances and targets, not on care (though I would suggest that this is the case for many Trust board meetings – certainly those I have seen). Perhaps more importantly, they failed to pay attention to the consequences of their decisions. For me, this is the key. Management decision-making can look all very reasonable and rational at a meeting or in a report. But we have to understand the consequences for the service they provide – particularly in a health care setting.