Abstract
The dust is finally beginning to settle following the Government’s response to the Francis report, and we are beginning to see what is actually going to change as a result. A few things still need to be bottomed out of course – not least the question of whether England introduces a full statutory Duty of Candour or some pale shadow of it, which could actually make things worse. This was discussed in some detail in a previous issue. At the time of writing, an announcement has yet to be made about this. However, whilst we eagerly await the Government’s decision – arguably the most central and important potential outcome from the inquiry – some things are becoming clearer.
The Government has made much of accepting the ‘vast majority’ of Francis’ recommendations. However, a closer look shows that many of these are accepted ‘in principle’, but the Government is actually going to do something rather different from what was recommended, if anything at all. Perhaps, the most noticeable changes have come in the approach to regulation, the need for which was so graphically exposed by the inquiry. Whilst some of the details of the recommendations such as merger of Monitor with the Care Quality Commission (CQC) were not accepted, the main thrust at least was taken to heart. We are already beginning to see a completely different approach from the CQC. A beefed-up inspection regime; a willingness to engage with and act on intelligence from patients and whistleblowers; and a much more open and principled style of leadership.
Some of the disappointments were the refusal to accept recommendations about introducing guidance on minimum staffing levels or to bring in regulation of healthcare assistants. These are decisions which I fear may come back to haunt ministers. Questions about staffing levels and skill mix, and indeed the effect of 12-hour shift patterns are, I fear, going to remain a huge issue. Even more so due to the strain on resources. The issues are commonly a red hot topic of debate in Wales, which has been facing its own Stafford-style scandals. More of that later.
Action against Medical Accidents (AvMA) expended huge amounts of time and its very limited resources in ensuring that there was a public inquiry and that the inquiry dealt with the issues important to patients. If we were to judge how worthwhile it all was purely on the basis of how fully the inquiry recommendations are being accepted and taken forward, we would probably be disappointed. However, there is a strong argument that the main benefits of all of this will come from the psychological, behavioural and cultural effects on people involved in healthcare. I have noticed the change in outlook – a willingness to accept that poor-quality care still continues to a significant extent and a passion to improve it. I have seen this in people I have met from ministers through to healthcare assistants. I place a lot of hope in that level of insight and commitment being sustained.
If this sounds naïve or uncharacteristically optimistic, allow me to qualify it. Whilst Stafford is in England, and the Francis recommendations pertain to England, it has been assumed that the cultural/behavioural benefits would be similar across the UK. However, recent experience in Wales casts doubt on that. AvMA has had to step in to offer support to families affected by poor care and neglect at Abertawe Bro Morgannwg Health Board in South Wales. The stories we have heard so far are reminiscent of Stafford, but it is too early to tell if it is on the same scale. There are calls for a public inquiry or at least a more robust, wide-ranging and independent inquiry there, and also a review of patient safety arrangements across Wales. Senior officials I have spoken to fail to see the parallels with Stafford. A series of ad hoc, piecemeal investigations are being commissioned – just like what happened at Stafford. One comment particularly worried me. ‘What could a review tell us that we don’t already know?’ When I retorted, ‘that’s what people said when an inquiry at Stafford was being called for and now everyone accepts that important lessons have been learnt as a result’, the response was ‘I doubt that they really mean that’. Worrying!