Come Friday afternoon, most people will be familiar with the key findings of the long-awaited Francis Report published formally on Wednesday 6th February 2013. Others will still be struggling to get through the 1,700 pages or so of evidence, analysis, and recommendations, which portrays a very dark side to an NHS that is there to protect and care for us.
Many of the findings into the failings at Mid Staffordshire NHS Foundation Trust came as little surprise; early leaks suggested that the investigations uncovered systemic failings within the NHS and that radical changes would be recommended.
For those who haven’t had a chance to read through the 290 recommendations, a quick summary of the key proposals set out are as follows:
- There should be a single regulator dealing with corporate governance, financial competence, viability and compliance with patient safety and quality standards for all trusts.
- There should be a legal duty of candour so that healthcare organisations have to admit their mistakes.
- There should be more powers to prosecute boards and individuals.
- Nurses to be held personally and criminally accountable for the care that they provide to their patients.
- GPs should undertake monitoring of their patients who attend/receive care from acute or specialist hospitals.
- Hospital boards should face dismissal if they fail to ensure minimum standards of safety and quality care.
- Only registered people should care for patients.
- Gagging orders should be banned.
- Subject to anonymisation, a summary of each upheld complaint relating to patient care should be published on its website.
- The transfer of functions of regulating governance of healthcare providers and the fitness of persons to be directors, governors or equivalent persons from Monitor to the Care Quality Commission.
- Those with oversight and regulatory roles in healthcare should monitor media reports about the organisations for which they have responsibility.
In addition to the scope and scale of the Francis Report there was something else that stood out to me – the way that a press announcement was issued stating that five more hospitals were now being placed under investigation.
To many this news/PR stunt was no doubt considered to be positive; surely it reflects that in light of the Inquiry’s findings, a visible change has already begun? NHS trusts are immediately being scrutinised and investigated in a more robust way to prevent this appalling and unnecessary suffering from ever happening again?
But in my mind this ‘timely’ announcement is a clear example of exactly what is wrong with the way issues such as high mortality rates are acted upon. The five organisations named had been categorised as having a ‘higher than expected’ mortality ratios for more than two years.
Yet, it has taken the publication of the Francis Report for an investigation into those trusts to begin. Professor Bruce Keogh, said that these hospitals are “already under scrutiny” but it appears that the people who we trust to look into under performing trusts have waited until a good press opportunity came about to actually launch a ‘clinically led and practical investigation’ that gets to the root cause of the problems.
This should have been done months ago when it was first brought to the regulators’ attention and not waited until there were enough trusts (five in this case) to make a more meaty news story or statement to the world about how failing hospitals will now be investigated and dealt with.
The Francis Report is by no means complete, the Department of Health will respond to the recommendations in the next month, meanwhile questions will be asked around how these recommendations fit with the existing reforms and how they can be implemented. But one thing is for sure, something as sensitive and important as patient safety needs to be shared with the public in the most open and honest way, without secrets, delays and excuses and certainly without any PR spin.
