With the publication of the Francis report looming, Dean Royles looks at what it may mean for the NHS
If 2012 was the year of the Health and Social Care Act, 2013 seems likely to be the year of the Francis report. It will let us take a long, hard look in the mirror.
A lot of extraordinary, unconditional care is given in the NHS and staff often show enormous bravery. I have often taken the view that the considerable amount of great care can somehow compensate for occasional poor care, while recognising the individual distress that this causes.
However, this argument is no longer good enough. In some areas, we are seeing an erosion in public confidence, with distressing stories about seriously ill patients asking not to be taken to certain wards and fears over the Liverpool Care Pathway. Comments about the “normalisation of cruelty” have made me take a long hard look at myself, my views and my values.
How do we, as employers of 1.2 million staff, convince the public that we are just as passionate about high-quality care as they are, that our commitment to good care is what gets us up in the morning and that we don’t just consider the balance sheet?
There is a lot of speculation about the Francis report. There is a widely held view that it will lead to a tsunami of change. Could it be coming at the worst time or the best time? Will huge financial challenges in the NHS prevent its recommendations from being implemented effectively, or will they provide the impetus for significant cultural change?
Regulators, professional bodies and other organisations will sense they have a part to play. It’s going to be significant for the HR function, which is often seen as the curator of organisational values - values that can both deliver exceptional care or fail patients.
All of us in the NHS will need to show that we are as determined as the health secretary will no doubt say he is to restore public confidence. Anything less will be a disservice to patients and the public.
Will the report recommend the regulation of managers? Would this apply to all managers, including registered professionals - or just board directors? Would it be voluntary or mandatory?
There has also been a lot of speculation from professional bodies about the regulation of healthcare assistants and minimum staffing ratios. Other organisations, including NHS Employers, have taken a cautious stance. Would minimum staffing ratios signal a staffing ceiling rather than a floor? What would this mean for the professional role of the ward manager, who is often best placed to judge the right mix of staff? Would regulating HCAs improve safety and dignity, or just allow a sanction after failure? Would it be better if instead of regulation we invested in developing standards, ensured access to training, provided good supervision and recruited and appraised staff against core values?
Any new approach should focus on early identification and support to keep patients and services safe, rather than identify poor performance after a tragedy. That will always be too little, too late.
It is essential that staff should be able to raise concerns but the NHS staff survey shows that around half of employees have no confidence action will be taken if they do so. We must put this right. Acting quickly and comprehensively on this has to be a top priority. Training, culture, leadership and policies will all play a part.
I - like many others - am speculating and taking a long, hard look in the mirror. We need a government and system-wide response to Francis and the horrors of Mid Staffordshire that will get us beyond the flurry of press coverage to sustainable solutions. These need to unite clinicians and managers in a common aim to provide the best-quality care, when care and compassion are what matter most. That’s what I hope the legacy of Francis will be.
Dean Royles is director of NHS Employers
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