Saturday, 9 February 2013

Should the Francis report recommendations replace the Health and Social Care Bill?

Robert Francis QC strikes me as (in the words of my grandmother) a sensible sort of chap. This may seem a frivolous start to any commentary on the Mid Staffs report, especially considering the horrors suffered by not tens, but hundreds of patients. But it is good sense that is needed to fix not only Mid Staffs, but the NHS in general.

This highly significant landmark in the future development of the NHS has been sublimely covered by the Health Services Journal and I am still absorbing the key points. I particularly like the infographic ‘how the report will affect the key players’.

But for simplicity, I am including some top recommendations highlighted by the BBC website:

·        The merger of the regulation of care into one body - two are currently involved
·        Senior managers to be given a code of conduct and the ability to disqualify them if they are not fit to hold such positions
·        Hiding information about poor care to become a criminal offence as would failing to adhere to basic standards that lead to death or serious harm
·        A statutory obligation on doctors and nurses for a duty of candour so they are open with patients about mistakes
·        An increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors

I haven’t assimilated all the information in this report yet but share the view of so many – how could this have happened and why hasn’t anyone paid for the ‘appalling suffering and abuse’ with their jobs?

The Francis report addresses ‘patient abuse and cruelty’, ‘corporate self-interest’, and ‘administration remote from the service at the front line’ He goes on to mention a ‘reluctance of those with the power to do so, to intervene urgently to protect patient’s interest’ and the ‘institutional culture’ is quoted as culpable.

I agree with Francis when he says that what is wrong cannot be cured by finding scapegoats. However in my opinion, that shouldn’t mean that those who must shoulder some blame should stay in post. From the ward to the boardroom – the key players and perpetrators should face the consequences of their action or inaction.

Cruelty and abuse was undertaken by human beings with free will. No-one made a nurse ignore a patient’s cry for help. The lack of conscience in a senior manager viewing their own professional ambitions and putting patients’ needs out of mind was a personal choice. Those with the power to intervene chose to ignore damning statistics and the pleas of distressed relatives.

In order to change culture, the top needs to lead by example. Anyone with some authority needs to think patient. Commissioners, chief executives, ward sisters and clinical leads must demonstrate that they care – in every sense of the word. They care about doing a good job, they care for the people whom they treat, they care for their colleagues and they care about outcomes. I absolutely agree with Francis when he recommends improvement in recruitment, training and education of clinical teams. I also agree that there should be one regulatory body monitoring care and standards.

Let us not forget that five other hospitals with above average mortality rates are facing investigations so Mid Staffs is not the only bĂȘte noire. I am a feisty, educated woman who understands how to play the system to get the best care, but even I have witnessed, and experienced at first hand a nurse being mean and a doctor ignoring my wishes.  So what chance would a vulnerable elderly patient stand?

The complex top down reorganisation as prescribed by the current NHS reforms will do nothing to address the care crisis faced by the NHS, but the recommendations by Robert Francis might just do it. Accountability, responsibility and honesty should be the NHS mantra.

What a pity that so much effort and resource has been applied to implementing Lansley’s Bill when the time and money could have been better spent addressing the real care crisis in our much loved, but nearly broken, state funded system. It just makes sense really - doesn't it?


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