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Francis calls for culture of care in NHS

Mid Staffs inquiry QC recommends jail for those hiding information on poor care

Mark Gould

Wednesday, 06 February 2013

Hiding information about poor care should become a criminal offence and the NHS should appoint a chief inspector of hospitals Sir Robert Francis QC says today in his long awaited report into the Staffordshire hospitals scandal. He calls for a change of culture in the NHS and for a zero-tolerance policy on hiding information about poor performance.

The public inquiry was commissioned by the government in the wake of the scandal where it was revealed that shocking lapses in care, poor management and failings in inspection and scrutiny might have contributed to between 400 and 1200 unexpected deaths at the hospital between 2005 and 2008.

The 1,781-page report catalogued missed opportunities at every turn between 2005 and 2008 - and said the findings still had relevance today four years after they first came to light in a 2009 report by the Healthcare Commission.

While it is well-known the trust management ignored patients' complaints, local GPs and MPs also failed to speak up for them, the inquiry said.

The local primary care trust and regional health authority were too quick to trust the hospital's management and national regulators were not challenging enough. Sir Robert recommends:

  • 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
  • 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

The inquiry which cost £13m is the fifth major investigation into what happened. It has focused mainly on the commissioning, supervision and regulation of the trust from 2005 to 2009 - something campaigners felt had not been properly covered before.

It sat between November 2011 and December 2012 calling more than 160 witnesses and hearing one million pages of evidence.

Prime Minister David Cameron will make a statement to the House of Commons later today but he is expected to back all or most of the recommendations in the report.

RCGP chair, Dr Clare Gerada said that while the Francis report focuses on failings in secondary care, it has implications for the whole of the NHS, including general practice.

She said: “Two major changes must happen in the wake of the Francis report if we are to provide the necessary reassurance that the lessons of Mid Staffs have been learnt and, most importantly, that the same mistakes will not be repeated elsewhere in future.

“Firstly, we need to refocus and restore patient care back to its rightful place at the heart of everything we do, across the entire health service from the most junior healthcare assistant to the most senior consultant.

“Clinicians, including GPs and their teams, must be given the ability to do what is most important: listening to patients and caring for them.

“GPs have so far ridden the storm but financial constraints and top-down targets are starting to adversely affect the level of care we can deliver to our patients. We need to reverse this trend by increasing the number of GPs available to provide patient care, and by ensuring they are free to focus their attention on what matters most to patients.

“The second lesson we must take from the Francis report is the need to create an environment in which health professionals right across the NHS can raise concerns on behalf of their patients without fear of recrimination, and where concerns will be properly and thoroughly investigated. In anticipation of the report, the RCGP has produced a UK-wide position statement on raising concerns and whistle blowing in the NHS that we hope will prove invaluable for GPs, hospital staff and patients."

Rick Stern the chief executive of the NHS Alliance which represents GPs, nurses and managers in primary care urged caution before imposing "more rules and stronger regulation" to ensure that this never happens again. 

He said that at the heart of the Mid Staffordshire failures was a culture where people felt unable or unwilling to challenge what was going on, and to ensure that caring for people and making sure that they are safe is always placed above finances. "There will need to be a cultural change, with a new emphasis on the power of the patient voice. At the same time, all of us working within the NHS will need to take responsibility, encouraging clinicians and managers to speak out when care is just not good enough. We all have a duty to respond to the challenges of this report," he said.

He added that primary care had a crucial role in this: "As the gateway to the NHS, general practice should be the first place that patients and communities go to make their voices heard, so it will be essential that GPs play the role of the ‘critical friend’, and ensure the patient voice is heard loud and clear, and the quality of local services remains high."

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