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.