Not the Francis Report

Mon, 15 October 2012

How to ensure Safety & Quality and prevent another Mid Staffs

On Monday 15 October, when Robert Francis QC was due to publish a delayed report into failures at the Mid Staffordshire Foundation Trust in 2005-9, National Voices - the health and care charity coalition - releases its own report calling for greater urgency in improving patient safety and care quality.

The report warns that there could be another “Mid-Staffs” while NHS planners and providers continue to “wait for further instructions”.

The report also says “There is also growing evidence of systematic deficiencies in the way our services are designed and run, and growing concern among patient and professional groups about the quality and sustainability of our heath and care systems”.
It says this is against a background in which the NHS is already under stress with funding “failing to keep pace with demand” and the NHS reforms are “distracting time and attention from front-line care”.

National Voices says “Waiting for Francis” is having a paralysing effect on improvements to safety and care quality, yet there is no reason to delay further in learning the lessons from Mid Staffordshire. The report also sets out National Voices’ own recommendations for ways forward.

The report recommendations include calls for:

  • A change in the law to create a “statutory duty of candour” to overcome “long-standing and persistent culture of secrecy, cover-up and authoritarian management in the NHS”. The report describes this as “a critical ingredient for preventing another Mid-Staffs”.
  • Implementation of the Dilnot reforms as a necessary first step for ensuring sufficient funding for social care. It describes “the lack of urgency in this regard is a scandal”.
  • Urgent work to ensure that the safety and quality of hospitals does not vary according to how old the patient is or when they are admitted, describing the current variability in services as “unethical and scandalous”.
  • A concerted drive by NHS organisations to involve and listen to patients and carers.

National Voices’ Chief Executive, Jeremy Taylor, says:

“There needs to be a much greater sense of urgency in implementing much needed improvements in the NHS if we are to prevent a repeat of the failings at Mid-Staffs.

“It is three years since failures in Mid Staffordshire came to light; since we heard how some people died unnecessarily and others suffered appalling care and indignities. The second Francis report has been delayed twice yet that shouldn’t stop us learning the lessons from Mid Staffs and other places.

“We already know what to do. There is no shortage of evidence to underpin improvements.
There is a great deal of consensus about what these should be. What is more, across the
country, countless dedicated health professionals and managers are quietly getting on with changes and innovations that are improving things for patients, service users and families.

“However, what seems to be lacking is any sense of urgency to get things done on a system wide basis. Instead, the massive effort of setting up new health bodies is sapping energy and time, and “Waiting for Francis” is having a paralysing effect.”

National Voices’ recommendations, as set out in the report, are:

  1. There needs to be a concerted drive towards creating an open and compassionate culture in all organisations providing health and care services, underpinned by accountability for upholding the NHS Constitution.
  2. National Voices welcomes the new Speaking Up charter launched today which sets out commitments to foster a culture of openness and transparency and to enable people to raise concerns safely and without fear of reprisal. But we also need a statutory duty of candour so that NHS organisations must come clean to patients and families where things have gone wrong. The current NHS Constitution pledge to be “open” is not enough.
  3. There needs to be a drive by the NHS and all care organisations to listen to patients and carers. This has to be a top priority for trust boards. Patient feedback systems need to be systematic and comprehensive, with results openly reported at all levels of management, so there is no hiding place for patches of poor care. The Friends and Families Test is a crude measure on which the NHS would be unwise to place too much reliance.
  4. There needs to be concerted effort to involve patients and families fully in decisions about their care and treatment, or “no decision about me without me” will remain an empty slogan.
  5. The NHS must invest in patient leadership: the leadership capability of people who play a  wide range of roles in supporting patients and service users, speaking out on their behalf, and helping to design services and hold them to account.
  6. The NHS Commissioning Board (NHSCB), local health and social care commissioners, and the professions need to lead on the creation of an integrated health service based around primary care. This has been talked about for decades but there has been little action. Key elements are preventive services; care planning and named care coordinators to help vulnerable people to live well and avoid unnecessary hospital admissions; and joining up health and social care services. Good out of hours care and round the clock crisis support are essential.
  7. The Government needs to implement the Dilnot reforms as a necessary first step for ensuring sufficient funding for social care and an equitable distribution of costs between taxpayer and self-funder. The lack of urgency is this regard is a scandal. Without these reforms, care will remain inadequate, efforts to join up services in the community will be hampered, and too many older people will endure avoidable hospital admissions.
  8. Urgent work is needed to ensure that the safety and quality of hospitals does not vary according to how old the patient is or when they are admitted. The current variability is unethical and scandalous. Trust boards should be held accountable for how well they reduce current gaps. Action is needed to implement the recommendations of the Royal College of Physicians’ “Hospitals on the Edge” report in particular, to improve continuity of care within hospitals.
  9. Hospital services need radical reorganisation. Safety and quality demand a greater concentration of some services. The NHS has a poor record when it comes to making a good case for change, involving local communities and winning support. Some important changes have been ducked for decades. National Voices has agreed to work with key system leaders on a methodology for doing this well, ensuring that local communities have a voice and that concerns - for example transport – are properly addressed.

  10. Regulation plays an important but limited role in ensuring quality and safety. There are many regulatory bodies and they need to concentrate their efforts on working smarter and better together. Extending the scope of regulation, for example by bringing managers and health care assistants into their purview, would in our judgement be wrong-headed. It would create bureaucracy and add little if any value.

Read the full report


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For National Voices media enquiries please contact: Jules Acton or Sarah Scadding on 020 3176 0737 / 0738

About National Voices
National Voices believes in people shaping health and social care. It is the coalition of more than 150 health and social care charities and speaks on behalf of its members and of the millions of patients, carers and social services users that they represent. It works to ensure that patient voices are heard and that they influence decisions at national level. National Voices' website.