Much has already been written about the report on the Mid Staffordshire NHS Foundation Trust public inquiry conducted by Robert Francis QC – the Francis Report.
At the core of these events is a simple human tragedy of avoidable death, suffering, pain and distress, loss of confidence and trust, and indifference – outcomes that should never have to be associated with an organisation (the NHS) that all still believe to be caring and above all rely upon.
The problems of Stafford are blamed on allowing a management focus on reaching national access targets, adhesion to achieving financial balances and seeking Foundation Trust status, at the same time as failing to listen to patients’ and staff concerns. This trust allowed an insidious negative culture involving the tolerance of poor standards to develop alongside a disengagement from management and leadership responsibilities. At the heart of this problem may have been the perception of the need to comply with repeated politically led reorganisations and so with an obsession with the 'system business' rather than the 'patient business'.
We should not forget that another profound change in the system is afoot at the moment which is having the effect of turning friendly GPs into managers. We should be very careful to remember the Francis Report’s primary cry that a common culture should be fostered, to be shared by all in the service, of putting the patient first.
The Francis Report makes the point that openness, transparency and candour need to be strengthened or in some cases created from scratch.
A great deal could be addressed if existing professional duties of candour were actually complied with and expressions of candour properly respected as professional duties by colleagues and managers alike. Much is made elsewhere in the current changes of a new 'contractual duty' of candour to be built into services commissioned by GPs. That duty will only apply to hospital doctors and not to GPs but the detail is lacking, particularly on whom involved in the treatment of the patient has that duty. Real change must remain doubtful without some profound alterations in attitude. The alternative of “whistle-blowing” may be protected in law and employment contracts but it remains perceived as equivalent to a letter of resignation. The duty of candour is closely related and without a profound change in the attitudes of all involved, the system will remain the same.
The Francis Report talks about development of a set of fundamental standards which are easily understood, the breach of which should never be tolerated. There is already the “Never” list of events in hospital treatment which the Department of Health decreed should never occur. A more general list, an amplification of the NHS constitution, is surely achievable.
But most importantly a culture must prevail that ensures that complaints are accepted and acted upon, staff concerns are welcomed rather than treated as acts of career suicide and where managers and clinical staff remember that wards are full of patients and not statistics.