You might think it was all doom and gloom in the NHS and
healthcare in general at the moment. And you may be right,
especially if you concentrated on the press and what was coming out
of Government and the regulators.
The Report by Robert Francis QC into Mid Staffordshire NHS Foundation Trust paints a damning picture of not only that organisation but of NHS culture generally, with more hospital trusts to undergo special investigations headed by Sir Bruce Keogh. Failures from the bottom all the way to the top of the system call for a significant shift to a more transparent and accountable model, where patients are treated with dignity and honesty, and senior figures can be found culpable for failings which lead to suffering.
In addition, the Care Quality Commission’s (“CQC”) latest annual report on Monitoring the Mental Health Act, covering the period 2011/12, tells of a lack of progress in service provision and “a significant gap between the realities CQC is observing in practice and the ambitions of the national mental health policy”. It reports that services are being run for the convenience of staff rather than patients, with a culture of coercion and containment prevalent over individualised treatment or patient involvement in care planning.
CQC has also recently reported into the provision of home care, finding that standards are not being met in important areas but that people were often too vulnerable to highlight failings because of a lack of expectation, a fear of reprisals or loyalty to their carer.
We’ve now read many patient and family stories which make us fearful of the care that might be received by our loved ones who go into hospital or care, particularly if they are elderly or vulnerable. These recent reports make us wonder whether things are actually changing?
To an extent, the reports paint a historical picture. The facts of Mid Staffordshire have been known for some time and quite rightly there was an urgent response to the events at Winterbourne View from commissioners and providers of that kind of care 18 months ago. The challenge for providers, commissioners, regulators, and us all, is to create real and lasting differences, and to avoid a depressing acceptance of neglect and low standards.
Each of these reports has a common theme about achieving change. Rather than take the Francis Report, which is still, I think, too new to comment on in detail, at least until we have a full reply from the Government, this is what the CQC Annual Mental Health Report says:
- Policy makers must consider the reasons why there are rising numbers of people subject to the [Mental Health] Act and develop an appropriate policy response.
- The Boards of [mental] health trusts, independent providers of mental health care, and community trusts are responsible and accountable for the quality of care people receive.
- The NHS Commissioning Board, local authorities, clinical commissioning groups and specialist commissioners must commission services that guarantee a person’s dignity, recovery and participation.
- The one group of people that CQC misses out of this agenda are
the patients and families themselves, although this is one area
where Francis concentrates. He recognises that patients and
relatives have a crucial part to play in telling us when the system
isn’t working and understands the need to raise the profile of
complaints as a key indicator of patient safety.
The Health Secretary Jeremy Hunt has been equally vocal in his criticism of organisations where failings have been identified – or are yet to be uncovered. Like Francis, he is aware of the importance of those who speak out about poor care and has spoken out against “gagging orders” that prevent whistleblowers from coming forward. Whilst this has merit, we need a system where such acts of whistleblowing (in one high profile case by a former Chief Executive) are rare because the warning signs have already been acted upon.
Clinical and corporate governance are not new concepts anymore, but in all industries these systems of governance and risk management need to constantly adapt to the challenges those industries face. Perhaps because it is so complex a system, or perhaps too fragile, we have applied less stringent rules to the human risks involved in health and social care.
In enforcement terms, the Health and Safety Executive is a much more powerful beast that CQC, both in terms of enforcement and in terms of perception. The HSE is feared when things go wrong because it actively prosecutes offenders on a strict basis, and its reputation has a strong preventive influence.
So when Jeremy Hunt calls for the police to investigate failures, or when Sir Robert Francis calls for individual prosecutions of senior management, do we think it is the way forward? In oil and gas it would be the norm, as it would be for a garden tree surgeon. Why not in health and social care? Not for all, but where it is deserved. That doesn’t mean everyone should fear for their future in healthcare, but rather it would likely mean that systems and information worked smarter – if the patients are safe, so are the management. And as safety shouldn’t be our minimum standard, it shouldn’t cause too much worry, should it?
I sense a real mood for change and it would be good to see positive improvements without the need for too many scapegoats. Indeed, let’s get back to championing what works and replicate it. Above all, we can’t be put off from making difficult decisions in a challenging economic environment – Mid Staffs shows us that.
Reports mentioned in this article can be found at:
- Francis Report – www.midstaffspublicinquiry.com
CQC: Monitoring the Mental Health Act in 2011/12; January 2013
CQC: Not Just a Number: Home Care Inspection Programme – National Overview: February 2013