Wednesday, 6 February 2013

First reports on the Francis report

This is a big entry and maybe not so interesting if you aren't interested in the subject. It's from the Independant - a barebones report of the reccomendations.

If that's all there is - it's a cop out.

While staff should be held criminally responsible when their is real neglect, putting the blame on staff is not the solution.
Failing to offer a system that works and simply relying on what we have, just isn't good enough.

I'll no doubt be ranting on again about this.....

The Independant;

Doctors, nurses and hospital managers should face criminal prosecution if they fail to provide basic standards of safe care to their patients, a landmark report recommends today.

The Francis Report into the lessons to be learnt from the scandal of Stafford Hospital calls for all medical staff to be made personally liable for their care they provide to their patients, and for a "zero tolerance" approach to poor standards.

They could also be prosecuted if they break a new statutory duty of "candour" which would require health professional to be honest with patients, families and healthcare regulators.

The inquiry chaired by Robert Francis QC was set up to assess the wider lessons to be learnt by the NHS from the Staffordshire scandal where up to 1,200 patients died unnecessarily because of widespread failings in both Mid Staffordshire Trust and the wider NHS.

He made a total of 290 sweeping recommendations for healthcare regulators, providers and the Government in his 1,782 page report. Among its main recommendations are:

* A new register for health care support workers - the lowest rung of caring staff in the NHS - which would be able to "strike off" poorly performing staff. There would also be a code of conduct and new minimum training standards for such staff.

* The creation of a new set of "fundamental standards" for care in the NHS which can easily be understood by staff, patients and the public. Any hospital or ward that does not consistently maintain these standards should be shut down by regulators. Non-compliance with the standards leading to the "death or serious harm of a patient" should be prosecuted as a criminal offence.

* There should be a criminal offence for any registered doctor, nurse or health professional to mislead regulators. They would also have an obligation of "candour" to patients or families - regardless of whether a complaint has been made.

The Francis recommendations will be met by relief by Department of Health officials who had feared he might propose another costly reorganisation of NHS.

He does not recommend that all NHS wards should have minimum staffing levels and while he is critical of the NHS standards watchdog the Care Quality Commission he does not recommend its abolition.

Instead he appears to put the onus on individual heathcare workers to ensure that patients are kept safe.

He says ward sisters and nurse managers should no longer be office bound and no ward round should take place without the presence of the nurse in charge of patients that are being visited.

"The extent of the failure of the system shown in this inquiry's report suggests that a fundamental culture change is needed," he says.

"That does not require a root and branch reorganisation - the system has had many of those - but it requires changes which can largely be implemented within the system that has now been created by the new reforms.

"I hope that my recommendations can put patients where they need to be - the first and foremost consideration of the system and everybody who works in it."

Francis said the problems of Mid Staffordshire were caused by the hospital prioritising targets over patients and a culture of fear which prevented staff from speaking out.

In a letter to the Health Secretary Jeremy Hunt he says the story is one of "appalling suffering".

"This was primarily caused by a serious failure on the part of the (hospital) board.

"It did not listen sufficiently to its patients and staff. It failed to tackle an insidious negative culture involving a tolerance of poor standards. This failure was in part a consequence of allowing a focus on reaching national access targets, achieving a financial balance…at the cost of delivering acceptable standards of care."

But he does not stop there and is highly critical of all parts of the NHS - from the multiple health regulators which existed at the time to the Department of Health which did not put doctors at the heart of the national decision making process.

In particular he is critical of the strategic health authority with responsibility for Stafford Hospital - which was run by the now head of the NHS Commissioning Board Sir David Nicholson.

It says the organisation was "readier to defend providers" than "to consider the implications of criticisms and concerns being expressed".

He also says it failed to be sufficiently sensitive to "signs that patients could be at risk" and dismisses excuses that it did not have the resources to monitor hospitals it was overseeing.

He points out that at no stage did the health authority complain about a lack of resources at the time.

However Sir David does not appear to be criticised by name and is likely to be supported by Mr Hunt given his critical new role under the Government's NHS reforms - despite calls from patients groups for him to resign over the scandal.

Speaking as the report was published, Francis said: "This is a story of appalling and unnecessary suffering of hundreds of people.

"They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.

"I have today made 290 recommendations designed to change this culture and make sure that patients come first.

"We need a patient-centred culture, no tolerance of non-compliance with fundamental standards, openness and transparency, candour to patients, strong cultural leadership, caring compassionate nursing, and useful and accurate information about services."

Mr Francis said various NHS bodies failed to pick up on the problems, and the Department of Health did not make sure ministers were given "the full picture".

He said although an investigation by the Healthcare Commission brought the problems to light, there was a reluctance by those who had the power to intervene urgently to protect patients.

Other organisations also failed to uncover concerns, and there was a failure "at every level" to communicate concerns with others and to take sufficient action to protect patient safety.

"In short, the trust that the public should be able to place in the NHS was betrayed.The chairman refused to blame failings on individuals or on one policy, saying there was an "institutional culture" where the business of the system was put ahead the priority of patient protection and public trust.

He said the NHS was full of "dedicated, skilled people committed to providing the best possible care to their patients", but said the service was in danger of losing public trust unless everyone in it took personal and collective responsibility.

Mr Francis said finding "scapegoats" or recommending reorganisations would not cure the problem, but only a "real change in culture" would help, focusing on "putting the patient first".

"We need a common, patient-centred culture which produces at the very least the fundamental standards of care to which we are all entitled at the same time as celebrating and supporting the provision and excellence in health care.

"We need common values shared by all, putting patients and their safety first. we need a commitment by all to serve and protect patients and to support each other in that endeavour."

He said those values should be the principle messages of the NHS constitution.

He said his recommendations aimed to bring "teeth" to changing behaviour, saying five things were needed - including a list of fundamental standards about patient safety and basic care, with any organisation that failed to comply being unable to provide a service, saying: "To cause death or serious harm to a patient by non-compliance with fundamental standards should be a criminal offence."

He said procedures and ways of assessing standards should be produced by the National Institute for Health and Clinical Excellence (Nice), including guidance on staffing, and support and protection for whistleblowers.

Standards should be policed by the Care Quality Commission (CQC), he said, including physical inspections as the most effective way of checking standards.
Neil Harris

(a don't stop till you drop production)

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