Professor Newdick focuses on; clinical culture, Mid Staffordshire and the influence of targets, reporting serious untoward incidents and understanding our clinical care culture.

1. Elderly care conference 2017
Culture, compassion and clinical neglect –
financial pressures and the experience of
Mid Staffs
Professor Chris Newdick

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Christopher Newdick Birmingham,
Barrister, University of Reading April 2017
CULTURE, COMPASSION AND CLINICAL NEGLECT -
FINANCIAL PRESSURES AND THE EXPERIENCE OF MID STAFFS
A. Clinical Culture, Mid Staffordshire and the Influence of Targets
Inquiry into Mid Staffordshire NHS Foundation Trust (Inquiry Report, 2010)
• a corporate focus on process at the expense of outcomes;
• a failure to listen to those who have received care through proper consideration of their
complaints;
• staff disengaged from the process of management;
• insufficient attention to the maintenance of professional standards;
• lack of support for staff through appraisal, supervision and professional development;
• a weak professional voice in management decisions;
• a failure to meet the challenge of the care of the elderly through provision of an adequate
professional resource. Some of the treatment of elderly patients could properly be characterised as
abuse of vulnerable persons;
• a lack of external and internal transparency;
• false reassurance taken from external assessments; and
• a disregard of the significance of the mortality statistics.
Inquiry into Maidstone and Tonbridge Wells Hospital (2009)
Inquiry into Stoke Mandeville Hospital (2009)
Care and Compassion—a Report on Ten Investigations into NHS care of older People (2011)
Dignity and Nutrition Inspection Programme—National Review (2011)
If you are in that environment for long enough, what happens is you become immune to the sound of
pain…You cannot feel people’s pain, you cannot continue to want to do the best you possibly can when the
system says no to you… (Mid Staffordshire NHS Foundation Trust Inquiry, 2010)
Speaking Up for Patients (BMA, 2009)
B. Reporting Serious Untoward Incidents
Code of Conduct for NHS Managers
 I will make the care and safety of patients my first concern and act to protect them from risk (p 3)
 I will act to protect patients from risk [and] seek to ensure that anyone with a genuine concern is
treated reasonable and fairly.
 Employers are asked to incorporate into the employment contracts of Chief Executives and
Directors … [and] “any other senior managerial posts, ie with levels of responsibility and
accountability similar to those of Director-level posts, to which they consider the Code should
apply.
Good Medical Practise (GMC, 2006)
You must protect patients from risk of harm posed by another colleague's conduct, performance or
health. The safety of patients must come first at all times. If you have concerns that a colleague may
not be fit to practise, you must take appropriate steps without delay, so that the concerns are
investigated and patients protected where necessary. This means you must give an honest

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explanation of your concerns to an appropriate person from your employing or contracting body, and
follow their procedures.
Management in Health Care: the Role of Doctors (GMC, 2006)
If you are concerned that a board decision would put patients or the health of the wider community
at risk of serious harm, you must ask for your objections to be formally recorded and you should
consider taking further action.
Care Quality Commission (Registration) Regulations 2009 - notification to CQC ‘without delay’:
(a) in the case of a person’s death where the death ‘cannot, in the reasonable opinion of the
registered person, be attributed to the course which that service user’s illness or medical condition
would naturally have taken if that service user was receiving appropriate care or treatment,’ and
(b) in the case of ‘other incidents’ in respect of ‘any injury to a service user which, in the
reasonable opinion of a health care professional, has resulted in: (i) an impairment of the sensory,
motor or intellectual functions of the service user [ie the patient] which is not likely to be temporary,
(ii) changes to the structure of a service user’s body, (iii) the service user experiencing prolonged pain
or prolonged psychological harm, or (iv) the shortening of the life expectancy of the service user;
Duty to notify the CQC without delay before any ‘other incidents’ have occurred if:
any event which prevents, or appears to the service provider to be likely to threaten to prevent, the
service provider’s ability to continue to carry on the regulated activity safely, or in accordance with
the registration requirements, including… an insufficient number of suitably qualified, skilled and
experienced persons being employed for the purposes of carrying on the regulated activity…
NHS Constitution
You should aim: to raise any genuine concern you may have about a risk, malpractice or wrongdoing
at work (such as a risk to patient safety, fraud, or breaches of patient confidentiality) which may
affect patients, the public, other staff or the organisation itself, at the earliest reasonable opportunity
[and] be open with patients, their families, carers or representatives, including if anything goes
wrong…You should contribute to a climate where the truth can be heard and the reporting of, and
learning from, errors is encouraged.
C. UNDERSTANDING CLINICAL CARE CULTURE
(a) Hippocratic Voices – Complicated and Complex Thinking
(b) Hearing Patients’ Voices
(c) Promoting the new Duty of Candour
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
20(2) As soon as reasonably practicable after becoming aware that a notifiable safety incident has occurred
a health service body must— (a) notify the relevant person that the incident has occurred in accordance with
paragraph (3), and (b) provide reasonable support to the relevant person in relation to the incident, including
when giving such notification.
(3) The notification to be given under paragraph (2)(a) must— (a) be given in person by one or more
representatives of the health service body, (b) provide an account, which to the best of the health service
body’s knowledge is true, of all the facts the health service body knows about the incident as at the date of the
notification, (c) advise the relevant person what further enquiries into the incident the health service body
believes are appropriate, (d) include an apology, and (e) be recorded in a written record which is kept securely
by the health service body.