Learning the lessons from the terrible failures of care at Mid Staffs demands ‘the engagement of every single person serving patients in contributing to a safer, committed and compassionate and caring service.’
This blog aims to open up debate and offer insights, updates, stories and personal reflections as I see things through my role in the Department of Health’s Francis Implementation Team.
Robert Francis QC’s public inquiry report made 290 recommendations affecting each and every level of the system from ward to Whitehall, stretched across 3 forensically detailed volumes, and amounting to a profound critique of the system that surrounded the Trust between 2005 and 2009.
This breadth and complexity can make it hard to distil, hard to know what the priorities are, and hard to keep in touch with all the activity currently underway. So this blog will attempt to offer some bite-size digests, with contributions, I hope, from a range of organisations and individuals across the system, placing a spotlight on a series of key themes, such as staff wellbeing, values and patient voice.
The public inquiry builds on Francis’ earlier independent inquiry’s exposition of the ‘insidious negative culture’ at the Trust. I’d urge readers to revisit the harrowing patient stories detailed in the second volume of that inquiry and remember why this matters so much.
Francis sets us a challenge to act together with resolve, courage and tenacity to make improvements. I was really energised and encouraged by attending NHS Confederation’s recent annual conference and getting insights into how people are engaging thoughtfully and reflectively with the inquiry’s critique of the system.
I met many people who are working through their professional associations, their teams and across their organisations to improve the quality of care. It was a powerful reminder that NHS staff have the passion, commitment, know-how and ideas to transform care. And that patients and families have the insights and expertise on what needs to change.
So, whilst the Francis challenge overall is huge and lasting, many of the solutions are simple and immediate. Small things like boards starting their meetings with a patient complaint or feedback can make a huge difference. Stories can be powerful weapons in changing cultures.
Registration is now open for a series of Francis response (regional events) during July and August to bring together national developments and celebrate best practice. And this blog aims to capture some snapshots of the innovation already underway, sharing ideas, ambitions, best practice, and sources of support.
Responding to the findings of the inquiry is not about a list of government ‘must dos’ to be neatly compartmentalised and added to someone else’s job. Nor can it be dismissed as yesterday’s news, a tragic failing in one aberrant organisation that the NHS has already learned from. Rather, it goes to the core of everything that matters about how the NHS delivers care, and its lessons extend beyond hospitals across public health, community health, mental health services and social care.
For me, responding to Francis is about ensuring everyone involved in care always sees, first and foremost, ‘the person in the patient’, listening to views and concerns, and involving people as true partners and experts in their own right. It is about how the system reacts when things go wrong, which we know they have done in some organisations.
There will always be mistakes and failings in the high risk, complex and emotionally difficult human business of healthcare. But we can choose to learn from these and prevent them rather than repeat them. It is about organisations being open and honest, creating a culture where staff can speak up safely and are supported to improve care.
At heart, responding to Francis means making sure that the quality of care – safety, effectiveness and experience – is everybody’s business all of the time.
It is a leadership challenge in which we are all leaders. It demands honest conversations, telling difficult stories, taking time as teams to reflect and learn, and keeping the Inquiry findings at the forefront of the debate.
It is rarely easy to speak up and speak out, or to challenge and change entrenched behaviours within complex systems. But I hope readers of this blog will together speak up loudly for quality and be a constant voice for compassion.
I am very keen to hear your views on the issues I raise in my blog, and any examples you want to share of how the changes we need to see are already being taken forward in your area, so please do comment and share your examples.
14 comments
Comment by Richard Wallace posted on
Please make a start in the Wheelchair Services! In Audit Commission report 2000, barely fit for purpose. Lot of time & money spent devising National Minimum Standards. 2004 they were completed ( updated 2010) Has anyone implemented them yet. Maybe 1 or 2 services. Problem Dept. Health have not acknowledged them officially. Here in MK "they're just guidelines, that is all, we don't have to follow them, we can make up our own rules."
Yes they will cost money to implement, but standards will be higher and less money wasted. See Kings Fund report.
Currently NHS Constitution breached, MHRA guidelines breached, Human Rights breached, NO CQC inspection because no stds. NO NICE stds on OT,s because no training programme, to name a few
If many Wheelchair Services don't meet them we want written justification that can be challenged.
Please don't sweep us under the carpet again, because somewhere someone will trip over it and break their neck like the NHS did in Mid Stafford or Winterbourne View.
Comment by William Perrin posted on
Hi Mary - how's it going?
how as a citizen, can i get involved in the governance of my local healthcare system to stop this sort of thing happening again? The Byzantine complexity of board structures is bewildering and I just can't see how to get stuck in with a patient viewpoint. Is there a weblink you can point me to?
cheers
w
Comment by Mary Agnew posted on
William - I hope this website will help you. Good luck and do keep me posted on how you get on.
Comment by Dr Charlotte Paddison posted on
Thank you for an interesting and perceptive blog. The challenge to speak up loudly for quality and to be a constant voice for compassion is an non-trival one, as you rightly point out, in the context of entrenched behaviour and complex systems. I agree that a cultural see-change to see the 'person within the patient' should be at the heart of our respose the Francis report and this issues it has raised.
But why should we limit our breadth of vision to listening better to patient voices only when things go wrong? My view is that we could also be much more proactive in how we engage patients in decisions about the commissioning of health care. You might ask: why should the public be involved in strategic choices about the design and improvement of health services? Perhaps because they are the ultimate recipients of the desirable and undesirable impacts of public policies; and because public engagement in health care decision-making encourages participative democracy, and public accountability.
Patients should also be involved in the design of health services because they have something unique to contribute: the perspective of someone who is ill. People who are healthy are most often in charge of decisions about the design and commissioning of health services. But there may be differences in what people who are healthy might view as being important in health care, compared to those who are ill. The experience of serious illness is rarely an emotionally neutral event. People who are ill, or have been ill, recognise the value of compassion in care delivery –potentially valuing this in a way that those who are healthy may not. A recent BMJ roundtable discussion highlighted the important of compassion in health care, and called for greater focus on compassion in the way we design and deliver care.
With the creation of Healthwatch and Clinical Commissioning Groups, we may see new opportunities to improve the quality of patient and public involvement in health services decision-making. Perhaps a timely change is afoot. This is needed if we are to address the call by the Francis Report to better value the patients’ voice within health care.
Comment by Mary Agnew posted on
Charlotte - thank you for your thoughtful response. I completely agree voice shouldn't be just about things going wrong and about the value of the unique insights of people who have experienced serious illness. I do think this is changing - but not before time and with a huge amount to do. I wonder if part of the challenge lies in people understanding the 'how'? I'm hoping to post some examples over the next few weeks of places that are doing really innovative and interesting work. The BMJ discussion sounds really interesting - will look it up!
Fiona - that's a very powerful definition, thank you. I'd be interested in your reflections on what helps people most to retain their compassion in the face of demanding jobs? We've been talking to experts about the value of reflective practice, for example, and also the NHS Confederation are currently undertaking a review of how excess bureaucracy might be tackled to reduce the pressures on staff. Interested in your thoughts on what can be done to nurture and support healthy cultures.
Comment by Mr P. Glenn. posted on
Untill Common Purpose graduates are no longer required in the NHS very little will change in the future.
Exploring Euthanasia - Government Destruction Of The NHS.
http://www.ukcolumn.org/article/exploring-euthanasia-government-destruction-nhs
A Conversation On The NHS.
http://www.ukcolumn.org/article/conversation-nhs
Britain's Final Solution.
http://www.ukcolumn.org/article/britains-final-solution
Comment by fiona cassells posted on
Fiona Cassells Senior Lecturer Nursing
Establishing a safe, open and collaborative working culture obviously is the one best for patients. If health care professionals are to be compassionate and caring they need to learn to manage themselves individually to avoid Burnout, their own managers must be supportive and understand this well researched phenomenon. People can get compassion fatigue and need to be educated as to how to avoid it. There is a definition by A Storlie, writing in the American Journal of Nursing in 1989, it still needs never to be forgotten by any policy maker, educator or manager in my opinion. It is above my desk to remind me what has to be done to best create high quality care.
“ Literal collapse of the human spirit-
transforming caring into apathy-
involvement into distance-
openness into self protection,
and trust into suspicion”
Comment by Michael Osborne posted on
Michael Osb
Service User Consultant (Voluntary) Notts Healthcare NHS Trust
Director Integritas Advocacy Charity
Fellow of the Institute of Mental Health
I am forwarding your comment on what can be done now :-
''So, whilst the Francis challenge overall is huge and lasting, many of the solutions are simple and immediate. Small things like boards starting their meetings with a patient complaint or feedback can make a huge difference.'' to the hierarchy of the Trust.
Notts Healthcare however do have an excellent record of patient involvement and feedback and I believe are leaders in the country recently winning the Patient Feedback Nationwide Award. I think all NHS meetings should have patient feedback on the Agenda. Michael..
Comment by Yvonne Sawbridge. Senior Fellow. healthServices Management Centre. posted on
Hi Mary- there is a rich stream of work looking to help organisations to recognise their responsibility for supporting staff in their daily task of emotional labour as Fiona describes. Boards know they have health and safety legal responsibilites and provide hoists for nurses to lift patients to avoid hurting their backs- but the notion of systematic support for staff to deal with their emotional work is rarely considered. it is left to chance. But hearts hurt as much (if not more!) than backs. We at Birmingham University are undetaking action reserach into models of emotional support (Sawbridge Y and Hewison A (2011) Time to care: Responding to concerns about poor nursing care. HSMC Policy Paper, Health Services Management Centre, University of Birmingham. (Available at http://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/PolicyPapers/policy-paper-twelve-time-to-care.pdf) ; and there are other models such as Restorative supervision (Sonya Wallbank) Schwartz rounds- Kings Fund Point of Care programme. Happy to be contacted further. Higely imprortant and complex arena.
Comment by Mary Agnew posted on
Yvonne - thank you. My team have been looking at some of this work and would be keen to talk to you about it. We're also delighted to be supporting the extension of Schwartz rounds - more information about these and evaluation is available here for readers who may not be familiar.
Comment by Francis Hone posted on
hi Mary unfortunately these problems are not unique to s staffs NHS there are training deficiencies for PO,s and structural issues at other NHS areas too as i witnessed 1st hand when my parents were admitted to Good hope in Sutton Coldfield Birmingham in 2012, I personally had to show the care staff how to extend the beds in two wards to make my father comfortable and block a draughty window to prevent a freezing wind blowing through the window. unfortunately both my mother and father passed whilst in good hope that year the level of care given was not of a high standard
Comment by Mary Agnew posted on
Francis - So sorry to hear this. I hope we're at a real turning point in addressing issues of poor care.
Comment by NHS career posted on
Hi Mary,
I think patient experience is very important. The experience is not only with clinical staff but also with non-clinical staff like receptionists and clerical staff. So non-clinical staff also be able to have adequate training to improve the experience.
Katie
Comment by Mary Agnew posted on
Thanks Katie. I agree. Making someone feel welcome and reassured in a hospital (or indeed any health or care service) can be so important in transforming what can sometimes be a very frightening or worrying time for people. Do you have thoughts on where this is done well?