NHS failings and the Francis Report

16 Jan 13
Paul Corrigan

The Francis Report into failures at Mid Staffordshire NHS Trust is likely to call for more national regulation. But there is an alternative response that encourages more public involvement and engagement

Both the government and the NHS are gearing up to respond to the Francis Report on Mid-Staffs that will be published in the next few weeks. Some trust boards have already set aside dates to think through the report and their response to it. Given the importance of the way in which culture works in NHS organisations, it will be vital that they develop ways to reassure the public that they have a culture of care and safety.

Culture – 'the way we do things around here' – sets the parameters for the way in which staff and patients operate. Board leaders thinking through how they help set the tone for their staff is a crucial part of the response.

But we also know that the Francis Report will make a number of recommendations about how the national system of NHS services is organised. Some of us have been trying, not very successfully, to make the case that increasing the amount of national regulation of NHS trusts may give people on the front line the impression that quality is an issue for national organisations and not front line staff and their culture.

The expectation is still that the report will demand more national regulation and that the government, having set up the report, will have no alternative but to carry out its recommendations to the letter.

On Tuesday 8 January Alan Milburn demonstrated how a powerful secretary of state can reframe the terms of a debate by writing an article in the Times providing an alternative response to the failures at Mid-Staffs.

He posed a direct alternative to regulation which would of itself have a much bigger impact on public empowerment than would employing hundreds more inspectors to write thousands more pages of reports. The essence of his argument was in the headline 'Patients can be the smoke alarms of the NHS'.

Just to unpick the analogy in that headline, 50 years ago the main defence against injury or death by fire in your home was the rapidity of the fire service’s response. Nowadays the first line of defence is the smoke alarm.

One of the main activities that fire-fighters now carry out is to encourage the fitting of fire alarms and to ensure they are kept fully functioning in as many buildings as possible. It is of course true that fire-fighters still save lives, but fire alarms with their much earlier warning save many more.

How does this relate to the provision of NHS services? Of course we need a public form of inspection. But given the public are there in every consultation and involved in all aspects of their health service, they need to be allowed and empowered to say that something is going or has gone wrong.

What Alan Milburn was arguing for was to complete the revolution that started a few years ago with the publication of more and more information in the public domain.

His point is: 'There is a direct relationship between giving power to consumers and improving standards. A decade ago I (Alan Milburn) had to fight to publish risk-adjusted data on heart surgeons. Today it is published by the society representing those surgeons. Since 2005 1,000 lives have been saved each year. Primarily this was because clinicians with relatively poor performance rates took steps to improve.' (The Times, 8 January 2013, page 8)

Only just over a decade ago not much was ever published about the NHS and its services. In September 2001, for the first time, the government published a set of star ratings about NHS provider trusts and, as he pointed out, more and more data has since been placed in public hands.

But it is still the case that my doctor friends know much much more about which providers are better and worse than the public do. We need all that information out there.
We then need all providers – public and independent – to be prepared to listen carefully to what the public are saying about the quality of care in all institutions. It is this that is the main line of defence against any drop in quality.

Milburn's point with regard to policy change following the Francis Report was that: 'With the best will in the world, regulators eyes cannot be everywhere. But patients and carers can'.

Much of my blogging these days explores the different ways in which patients must be more involved in adding value to their own health care. Playing the lead role in keeping quality standards high would be another part of this new compact.

Paul Corrigan was formerly senior health policy adviser to Tony Blair when he was prime minister. This post first appeared on Health Matters


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