The lessons learned and recommendations set out in the Francis report are clearly intended to have an impact outside Stafford Hospital. Among many problems highlighted the report identifies: A lack of openness to criticismA lack of consideration for patientsDefensiveness
“I suggest that the Board of any Trust could reflect on their own work in the light of what is described in my report”. Robert Francis, QC
The lessons learned and recommendations set out in the Francis report are clearly intended to have an impact outside Stafford Hospital. Among many problems highlighted the report identifies:
More particularly the findings identify an organisation that was characterised by:
The wider lesson is borne of the acknowledgement that it cannot be suggested that all these characteristics are present everywhere in the system all of the time, but their existence anywhere means that there is an insufficiently shared positive culture. The report advocates a relentless focus on the patient’s interests and the obligation to keep patients safe and protected from sub-standard care.
The recommendations set out in the report have a broad ambit, but those which will have an impact on clinical practice and governance are outlined below.
Enshrined in the NHS Constitution and systems regulations should be a commitment to abide by an integrated hierarchy of standards:
The report warns that unless steps are taken to evidence the importance of candour by the creation of some uniform duty with serious sanctions available for non-observance, a culture of denial, secrecy and concealment of issues of concern will be able to survive anywhere in the healthcare system. This is reflected further in Recommendation 173:
Every healthcare organisation and everyone working for them must be honest, open and truthful in all their dealings with patients and the public, and organisational and personal interests must never be allowed to outweigh the duty to be honest, open and truthful.
A statutory obligation should be imposed:
The obligations which are embraced in the duty of candour as set out at Recommendation 181 include:
The provision of information in compliance with this requirement
should not of itself be evidence or an admission of any civil or
criminal liability, but non-compliance with the statutory duty
should entitle the patient to a remedy. In other words, an
apology must be made, an explanation given and while that on its
own should not have consequences, not doing so will. If, as
Recommendation 183 suggests, a breach of the duty of candour is to
be a criminal offence, this raises the spectre of staff being
potentially caught between a duty of candour and a legal
entitlement not to give evidence which might incriminate them.
Elsewhere in relation to dealings with Coroners, Recommendation 273 suggests that:
The terms of authorisation, licensing and registration and any relevant guidance should oblige healthcare providers to provide all relevant information to enable the coroner to perform his function, unless a director is personally satisfied that withholding the information is justified in the public interest.
This is consistent with the Court of Appeal judgement in R (Mack) v Coroner for Birmingham and Solihull  EWCA Civ 712. There, reservations were expressed about a practice of a Coroner relying on a hospital’s view as to what should or should not be disclosed in an inquest.
In addition, the report notes that whilst describing the NHSLA Guidance on Apologies and Explanations as "a commendable attempt to promote openness", it recommends that the guidance be reviewed by the NHSLA, and all other organisations with published guidance or policies on disclosure of information about incidents to patients, to ensure consistency with the report's proposals.
The public should be able to compare relative performance, and therefore need access to open, honest and transparent information to assess compliance with appropriate standards. This should include information about the performance and outcomes of the service provided to enable patients to make treatment choices and have a proper understanding of the outcomes for them. This should lead to:
It should be a professional duty of healthcare professionals to
collaborate in the provision of such information.
In the coming weeks Bevan Brittan is hosting a series of
seminars across its offices to consider the implications of the
Inquiry more fully. Following these we will issue more detailed
briefings on what the Inquiry's conclusions mean for different
players in the system. The scheduled dates for these seminars are
Bristol: 20 February 2013Birmingham: 26 February 2013 London: 14 March 2013
Please click on the above dates and locations to view further details and to register for the seminars.