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Will the Mid Staffs inquiry be the end of a terrible chapter in the NHS’ history – or the beginning?

The publication last week of the Francis Inquiry report – and the response from the Government delivered by David Cameron – felt like a landmark moment in the history of the NHS. So much has been written by so many about its significance, what went wrong and what can be done to stop it going wrong again, that it’s hard to see what more can be said.

But there is one pressing question which could have a profound effect on the immediate future of the health service, and it’s the obvious one: how many more Mid Staffs could be out there?

In the wake of the Francis report it was announced that NHS medical director Sir Bruce Keogh would head up an investigation into mortality data at five hospitals which appeared to report unusually high death rates between 2010 and 2012.

Yesterday a further nine hospitals were added to that list, bringing the total under investigation to 14. According to estimates published in the Daily Telegraph, there could have been as many as 6,000 ‘excess’ patient deaths across those 14 trusts.

It’s important, at this point, to add a note of caution. As Dr Margaret McCartney noted in her recent column, HMSRs, or hospital standardised mortality statistics, come with a health warning attached. There are all kinds of possible explanations for outlying mortality rates – which is presumably why further investigation is required. But that said, it seems likely further concerns about hospital care will emerge.

A year ago this week, Pulse and its sister publication Practical Commissioning published the findings of an in-depth survey of 500 GPs, in which we asked them about the standard of care at their local hospital.

There’s no pretence, of course, that this kind of poll is statistically rigorous, but as a snapshot of the profession’s opinions about their local secondary care it was a useful one – and the findings were genuinely shocking.

One in seven GPs said one or more of the departments in their local hospital was ‘dangerously substandard’. One in ten GPs said one of their patients had died within the last year potentially as the result of substandard hospital care. A third had raised concerns with their local hospital, but fewer than half were confident their concerns would be acted upon.

It wasn’t all bad – 78% said they would recommend their local hospital to their patients. But in a substantial minority of cases there were clearly very real concerns. One in five GPs said they had confidentially warned patients about a hospital’s standard of care within the past year, and 21% said they would not want their own family being treated there. The anecdotes we collated – of patients going unfed and unwashed, of missed diagnoses and of diabolical communications – make for harrowing reading.

There will, of course, be far-reaching changes as a result of the Francis Inquiry, mainly within secondary care or the regulatory arena. In primary care, the key message for GPs seemed to be that they should perform an independent ‘monitoring’ role with regards to hospital standards and that they should speak out when they identified concerns.

But if the findings of last year’s snapshot poll are anything to go by, then GPs may struggle to make their voices heard. And the stories about substandard secondary care - never likely to have been limited to just one small hospital in Staffordshire – will run and run.

Steve Nowottny is the editor of Pulse. You can follow him on Twitter @stevenowottny or email him at