Francis – the NHS isn’t working
The publication of the official public inquiry report (three volumes of it) into the failings in Mid Staffordshire Foundation Hospital by Robert Francis QC, has been labelled as the watershed moment for the NHS, as it lays bear the wide spread knowledge of the significant failings in basic care and compassion at then hospital which can be extrapolated across the NHS. What this report highlighted is not just failings on the wards of the hospital, or even in the boardroom of the hospital, but systematic failings in the NHS system as a whole, from the Department of Health downwards, as well as the regulators of health professionals, especially the Nursing and Midwifery Council and the General Medical Council, as the report states the institutional culture was one that ‘’put the business of the system ahead of patients”
Despite the significant and deplorable failings at the hospital with over 400 people dying needlessly between 2005-2009, no one person has been prosecuted and neither has any organisation been subjected to court proceedings under the Health and Safety Act. If this was any other industry, there would be a police investigation and a Health and Safety investigation and no doubt a prosecution. The NMC and GMC did today state that some of the nurses and doctors involved in the hospital during that time are facing disciplinary hearings, but it seems this is 4 years too late for them to act!
Unfortunately this scandal is neither the first nor will it be the last to engulf the NHS, from the Kennedy Inquiry into the Bristol heart scandal to Harold Shipman. In fact back in 1965 a letter to The Times newspaper highlighting the appalling manner in which elderly patients were treated in mental healthinstitutions, led to an investigation in 1967 which concluded that the NHS hierarchy denied problems and dismissed complaints as unfounded even with strong evidence and tried to ignore the complainants in the hope they will go away, a similar conclusion drawn by both the Kennedy and Francis inquiries. It has been reported widely that the Francis Inquiry has been inundated with families asking for investigations in to numerous other incidents of appalling neglect that has resulted in death of their love ones in different hospitals across the country.
The 290 recommendations of the Francis report calls for a fundamental shift in the culture of the NHS. The recommendations include, a new legal duty of candour, everyone in the NHS will be required to abide by the principles of openness, honesty and truthful and will be required to highlight issues and concerns about the care and dignity of patients. Individuals and organisations should face criminal sanctions if they are responsible for breaching fundamental standards resulting in serious harm and death. Directors of organisations providing health services should be fit and proper people and abide by the code of conduct, although this falls short of regulation of managers, it does provide the regulators with the power to remove and in effect disbar individuals breaching this standards. The other recommendations can be read on the Inquiry website. We will find out next month how many of the recommendations will be implemented by the Government, when a detailed response is due. However, the Government and some health experts are already questioning the practicality of implementing some of the recommendations, for example the merger of the two regulators the Care Quality Commission and Monitor, as this will be cause upheaval at a time of immense challenges in the NHS, and the duty of candour as this may increase clinical negligence claims against the NHS. The Government has announced the creation of a Chief Inspector of Hospital and a friends and family test!
Whatever the Government implements, the fundamental issue is how can humans, providing care to people at their most vulnerable period, lack humanity and care for these people and instead contribute to their suffering. This is a question for the whole of society not just the NHS system, yes the system should be setting the fundamental principles, but at the end of the day it is the individuals that provide the care on the wards and sit around the board table that should show a sense of humanity and emotion to ensure the best care possible can be provided to people when they come to you at their most vulnerable time.
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