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Reaction to the Francis Report - a summary

John Illingworth
John Illingworth
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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.





 
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Comments
I address in particular, your last paragraph.
Years ago, when I was a young and enthusiastic Nurse, the decision was made that the NHS needed to be run along business lines.
How my colleagues and I laughed at this idea.
It could never work.We all agreed that business and the patient could not BOTH be king.
We were in service to the patient - there to do our best for our charges - not in any way aligned to business. Daily our patients told us:
"We feel so safe in your hands." .

In these early days of Nursing, and throughout the seventies, I saw no episode of abuse or lack of respect. From the late eighties through to the early nineties, I saw a gradual decrease in standards and respect. I documented the first case of cruelty I witnessed. However, the events were copious, ongoing and depressing, and latterly I was so disgusted by the treatment I witnessed. I could not, in all conscience, continue to serve in my chosen profession.
Today, I could not name with confidence any hospital in the country which puts the patient first, and treats him/her with respect at all times.
What a sea change!

.
Unless and until we refocus totally, the service is doomed.
You can have all the reports and inquiries in the world - it will not change the facts: the focus is wrong.

If you want excellent patient care, the ONLY focus is the patient.
We were all very aware that it was the patient that we served. If it is to be supported by business, there should be a business arm. The two should not conflict - which they did latterly in my career.
Has anyone thought of asking the patients of today:
"How safe do you feel?"
This open question would reveal where there are problems with staff behaviour.
It would be a gauge for their confidence in the system, and this has a direct effect on their recovery.
If we want our patient to feel safe and cared for, why should we not put the question to the patients?
They know the answer -they will identify problems, and they will appreciate being asked.

I totally agree with your comments.
Sadly, the patient has no voice - only a lip service to' client centred care.
I have been shocked by the responses from several clinical leads and managers, when issues of poor practice had been brought to their attention.
Much of the Nhs is shrouded in secretecy, having been a qualified nurse since 1976, I can honestly say in my experience the calibre of many nurses and health care assistants today begs belief.
Ignorance, lack of compassion and empathy appears to be common place. Bring back the schools of nursing to local hospitals, where nurses are trained and closely followed through the different areas and services over a 3 year period.
Weed out those, who are not able to deliver high quality care, show lack of concern and display inappropriate attitudes in practice..
After 30 years in the US hospital industry and recently 16 years in patient advocacy I am encouraged by this report and the responses of your primary care physicians and nurses.

I have always believed the patient must come first and the caregivers who give daily hands-on care to patients will continue to affirm this fact. The US sent J Edwards Deming to Japan to teach Continuous Quality Improvement (CQI) and look at how it changed the auto industry both there and in the US. England stands to realize such change by applying (CQI) to your response to the Francis Report----"The customer comes first" and in healthcare the patient is clearly the customer and ultimate end-user.


Edwin Childs Institute for Quality Improvement
Patient Advocacy Organization
edlchilds@comcast.net
USA
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