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Trust got new status despite issues

At the height of its troubles, Mid Staffordshire NHS Foundation Trust was awarded foundation trust status - a supposed marker of excellence in the NHS.

The trust, which was made a foundation trust in 2008, was on Wednesday criticised for "prioritising its foundation trust application over its quality of care".

Robert Francis QC, chair of the inquiry into what went wrong at the trust, also panned the regulatory body Monitor which awarded the trust the status. He said the regulatory assessment process "ought to have brought those deficiencies to light" and Monitor's failure to do so "calls into question the effectiveness of the FT regulatory system as a whole".

Mr Francis said Monitor should be stripped of its powers to award foundation trust status, with the powers handed over to the Care Quality Commission (CQC). But he also noted that the CQC "has had many challenges since its inception", adding that the inquiry heard evidence which "does not suggest that the CQC is a happy place to work in".

In a statement, the regulator said: "Monitor profoundly and sincerely regrets the events that took place at Mid Staffordshire NHS Foundation Trust during the period covered by the public inquiry and, in particular, the shocking experiences of the patients and their families which have been so movingly described during both this inquiry and the independent inquiry which preceded it. The standard of care that patients received was unacceptable.

"We accept without hesitation our share of responsibility for failures in regulation during the period in question. We authorised a trust which in retrospect should not have been authorised and could have used our formal intervention powers sooner once problems had been uncovered.

"We have learnt from the mistakes we made and have already made significant changes to the way we work as a result of what happened at Mid Staffordshire."

CQC chief executive David Behan added: "No system can guarantee that there will never be failings. Regulators and supervisory bodies must be much better at identifying and challenging poor care and in working together to improve people's experiences of care. And boards, managers, care staff and commissioners must take responsibility. And we must all listen to patients.

"Today's statement by the Prime Minister sets clear objectives for CQC which strengthens our role as regulator. We will continue to operate as a single, unified regulator across health and social care."

He added that a new Chief Inspector of Hospitals will enable the regulator to have a "sharper focus on hospital care".

The report also criticised local health authorities for having a degree of oversight.

Mr Francis said that West Midlands Strategic Health Authority (WMSHA) "became far too remote" from the patients it served. The SHA also "failed to be sufficiently sensitive" to signs that patients might be at risk, he said.

Head of the NHS Commissioning Board, Sir David Nicholson, who is facing calls to resign following the publication of the report, was chief executive of the WMSHA between August 2005 and April 2006.

He said that primary care trusts were under a duty to monitor and improve the quality of services they commissioned but there was a "significant gap" between the PCTs' role and their capacity to deliver.

Mr Francis said that structural reorganisations of SHAs and PCTs in 2005 and 2006 "appears to have been conducted without any assessment of the risks to patient safety".

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