Today we celebrate the 65th birthday of the NHS, a truly tremendous achievement of which we should all be very proud – I certainly am. The NHS “works at the limits of science – bringing the highest levels or human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most.” In my early 20s, when I was struck out of nowhere by a rare kidney disease, the NHS team restored me to health and probably saved my life. More painfully and privately, I am deeply grateful for the medical, surgical and imaging expertise and the compassionate multidisciplinary care it has provided and continues to provide to those closest to me.
However today also strikes me as a timely point to reflect on the core values and principles that have underpinned our NHS for the last 65 years. Values, as set out in the NHS Constitution, such as respect and dignity, commitment to quality of care, working together for patients and compassion. These values were not evident in too many cases at Mid Staffs. To quote Robert Francis at length, the Inquiry found that for many patients:
“The most basic standards of care were not observed, and fundamental rights to dignity were not respected. Elderly and vulnerable patients were left unwashed, unfed and without fluids. They were deprived of dignity and respect. Some patients had to relieve themselves in their beds when they offered no help to get to the bathroom. Some were left in excrement stained sheets and beds. They had to endure filthy conditions in their wards. There were incidents of callous treatment by ward staff. Patients who could not eat or drink without help did not receive it. Medicines were prescribed but not given. The accident and emergency department as well as some wards had insufficient staff to deliver safe and effective care. Patients were discharged without proper regard for their welfare.”
This was shocking in the extreme, yet failures of compassion and safety can and do happen in smaller ways across the system. Paradoxically, great care and callous care can sometimes co-exist in the same organisation. Many of us can recount experiences of seeing food left out of reach and then removed, or needing to chase up essential medicines or pain relief for loved ones. And these things matter. Proper nutrition helps healing; serious illness is frightening and how much more traumatic where fundamental human needs go unmet. So we need to refocus on getting the fundamentals right for everyone all the time. We all know this and want to achieve these – but in a very busy service supporting more acutely ill people with complex needs, concerted focus and priority is needed to tackle the things that can get in the way of delivering the fundamentals of care.
Central to Robert Francis’ recommendations is an emphasis on a common set of fundamental standards about the basics of care – and that breaching these standards should never be tolerated. You can contribute to shaping what these fundamental standards should look like by responding to the Care Quality Commission’s consultation document ‘A New Start’. This sets out their plans to improve inspection and asks a series of key questions to establish whether a service is safe, effective, caring, responsive and well-led. The consultation closes on 12 August.
This is a really important consultation covering several key areas of taking forward the response to Francis. You can give your views on the plans to improve inspection, with Chief Inspectors leading expert inspection teams, develop a ratings system to help people understand how well services are performing, and introduce a statutory duty of candour requiring providers to ensure their staff and clinicians are open with people and their families where there are failings in care.
Of course, external regulation is a vital check, but the real upholders and defenders of fundamental standards are closer to care: patients and families as the eyes and ears in every part of a service, professionals whose behaviour and ability to both inspire and challenge colleagues is where quality is made or damaged; and the Board of an organisation that sets the tone and has a key role in assuring itself that fundamental standards are being met on every shift, ward and department. The NHS Leadership Academy has just updated guidance on the roles and responsibilities of Boards. This highlights the importance of executive and non-executive directors engaging directly with staff, patients and the public, listening to complaints, concerns and suggestions and acting on them fairly. It stresses how quality needs to be at the heart of Board discussions and their vital role of Boards in shaping cultures, both intentionally and passively through the signals it sends by what it invests its time in.
Francis made important recommendations about the care of older people. The department is today launching proposals about improving the care of older people, including that vulnerable older people with complex needs should have a named clinician responsible for their care outside hospital. We would welcome your views at the better health and care site.
Thank you again for taking the time to read my thoughts. Please do share your comments and reflections below or you can send them to francisresponse@dh.gsi.gov.uk. I’d be particularly interested to hear of your examples of organisations and teams delivering excellent compassionate patient-centred care. You have until 26 July to enter a new Compassionate Patient Care category of the HSJ Awards 2013, which is supported by the Department of Health. There is so much to celebrate, learn from and be inspired by on this 65th birthday.
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