Any doubts we might have had about the scale and reach of the Francis Inquiry were put to rest at around 11.35am on Wednesday 6 February, when the final report was laid before Parliament and laid bare before the country. Revelations of events at Mid Staffordshire continue to shock and shame us, but those organisations responsible for taking action have begun the process of digesting the findings and recommendations.
The report will be essential reading for the board of every organisation that is responsible for commissioning and providing care. Each organisation will respond in its own way, but none will be in any doubt that its contents are the number one priority for months and even years to come.
Cure the NHS, the group of relatives and patients who campaigned for the public inquiry, responded by continuing to call for those who are responsible for the failings to be held to account.
The Prime Minister took a number of immediate steps, which include the creation of a new post – a Chief Inspector of Hospitals – who will take personal responsibility for making an explicit and public judgement on the quality of care in hospitals. The NHS Commissioning Board has promised ‘fundamental change’, launching investigations into five hospitals who have had significantly high mortality rates for two successive years to 2012.
So how did the many other organisations involved in the delivery and improvement of healthcare respond to the main findings of the report?
Here at the Health Foundation we welcomed the prominence placed in the recommendations on changing the culture of the NHS, by treating patients as people, with compassion and dignity. We also welcomed the move to develop fundamental standards for providers. But we remain concerned that these alone will not change organisational culture and provide a guarantee that care is safe.
A number of organisations also focused on the imperative to change cultures. The Royal College of Midwives welcomed the effort to ensure that ‘those who need to raise concerns about the care provided feel happy and secure in doing so’. Similarly, organisations including the Royal College of General Practitioners felt that the report highlighted the consequences of what can happen ‘when the NHS loses sight of patient care on the ground in the scramble to balance budgets and achieve targets’. The Royal College of Physicians, a core participant to the Inquiry, stated that care pathways must be designed around patients’ needs and ideally co-designed with patients to reflect changing demands.
The report made explicit the need to work within the structures that have recently been subject to further reform in England; however many of the recommendations will still require legislative or structural change. Jennifer Dixon, Chief Executive of the Nuffield Trust, questioned the wisdom of merging the Care Quality Commission and Monitor: 'There are more pressing priorities and structural remedies often don't deliver the solutions they set out to. The history of merging already large regulators is mixed at best and we should proceed cautiously.'
In a report described variously as a ‘forensic analysis’, ‘comprehensive’ and focused on the ‘whole system’, it is vital to bear in mind that the causes of the events at Mid Staffordshire were complex, and the solutions required across the system are diverse. The King’s Fund reminded us that real change will only come by addressing mindsets:
'Even if all 290 recommendations were implemented now, the fundamental shift in culture can only be achieved if patient care is put top of the agenda for boards and is the first responsibility of professionals working in the NHS. That will take time and commitment over many years.'
Possibly the highest profile recommendation was to introduce a statutory duty of candour. This was warmly welcomed by groups, such as Action against Medical Accidents, that have long campaigned for a legal requirement to be open with patients who have been harmed during their care. However National Voices – which represents 130 health and social care charities – argued that the report could have been more radical in calling for a stronger voice for patients, and that it could be read as making a paternalistic system stronger, ‘where patients are still responding to the system from the outside’.
It is this point that Stephen Thornton, our Chief Executive, makes in his response to the report. That while there are a great deal of positive recommendations, he asks ‘where is the patient in all this... nowhere does he say that patients should be involved in decisions about their care and treatment... It runs the risk of an undue reliance on the system getting it right for the patient. We know all too well that this is not enough.’
John is a Policy Manager at the Health Foundation.