Comment

Sir Stephen Moss: We must not repeat the mistakes of Mid Staffs

The NHS is experiencing many of the pressures that led to catastrophic failures of care at Mid Staffordshire NHS Foundation Trust. The trust's former, troubleshooting chairman says an increase in funding and properly supported STPs are essential to avert another tragedy and put the NHS on a sustainable footing.  

The NHS is experiencing many of the pressures that led to catastrophic failures of care at Mid Staffordshire NHS Foundation Trust. The trust's former, troubleshooting chairman says an increase in funding and proper support for STPs are essential to avert another tragedy and put the NHS on a sustainable footing


Sir Stephen Moss, former chairman of Mid Staffordshire NHS Foundation Trust,
says STPs are laudable but 'loaded with risks'. 

These are exceptionally tough times for everyone involved in providing care and treatment across NHS settings. Colleagues on the front line face unprecedented pressure day in, day out, without any respite and often with limited resources. As a nurse it distresses me greatly to see graphic images of elderly, frail patients waiting for long periods on trolleys in overcrowded emergency departments.

We have to address the current unsatisfactory situation and bring about sustainable, long-term improvements for patients and staff. To do nothing is not an option.

I welcome the development of Sustainability and Transformation Plans (STPs) in England because for the first time there will be real partnership between health and local authorities to address the health needs of their communities, focusing on prevention, quality care, value for taxpayers’ money and the workforce.

However, to succeed, STPs will require radical, system-wide transformation, and while their aspirations are laudable, they are loaded with risk. Overstretched staff, who will be expected to keep the service going while all of this happens, are understandably anxious.

No silver bullet 

STPs are our best chance of putting health and social care on a sounder footing for the future. But I am worried about how they will be implemented, and how front line staff will be supported throughout the process. If the changes are not managed effectively and sensitively, the solution will become part of the problem.

I am also greatly concerned that STPs are seen as a silver bullet for all of the problems in the NHS. In my three years as chairman at Mid Staffordshire NHS Foundation Trust, I saw first-hand what happens when managers and leaders take their eye off the ball, and staff are left unsupported and often set up to fail. The current issues of increasing demand, unremitting pressures, workforce shortages and challenging financial imperatives are all too familiar, and all were prevalent when I joined Mid Staffs. 

Some fantastic improvements have been made since Sir Robert Francis reported on Mid Staffs, but I genuinely fear that there is a real possibility of further care scandals. We must not allow our focus on patient safety and delivering high quality, compassionate care to be diverted.

It is vital that trust boards recognise this and make sure they do not lose sight of what matters to our patients, their families and our staff. I will never forget, at Mid Staffs, the total loss of public confidence and the demotivated ‘war weary’ staff. We owe it to those we serve to make sure it never happens again.

Actively engaged 

First of all, we have to make sure that patients, local communities and our staff become more actively engaged in the STP process, and that their views are listened to and acted on. We also have to make sure that every part of the system has the necessary skills and commitment to transform care pathways, and the change is delivered at a pace that ensures that all of the component parts can fit together seamlessly and safely.

We have all seen valiant attempts to manage demand fail miserably in the past, and front line staff and patients will take some convincing about bed cuts and more care in the community.

Delivering STPs effectively and safely may well require additional pump-priming money. There also needs to be recognition that the system-wide change described in STPs is not enough, on its own, to solve all of the current problems. There has to be an increase in overall NHS funding in line with other developed nations. Only then will we see the benefits of system-wide transformation for our patients and our loyal, hard-working colleagues at the front line of care.


Sir Stephen Moss is a non-executive director and senior independent director at Derby Teaching Hospitals NHS Foundation Trust, and non-executive director at Health Education England. In 2009, he was asked to chair Mid Staffordshire NHS Foundation Trust, following a highly critical report from the Healthcare Commission. He is writing here in a personal capacity only.  

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