The whole tone of the government’s response to the Francis report concerns me, says Katy Meade
Described as “a story of appalling and unnecessary suffering of hundreds of people” by Robert Francis QC, the Mid Staffordsire Foundation Trust Public Inquiry listed systematic failures at every level of the NHS. Findings of “corporate bullying” and “insidious negative culture” point to deep-seated problems that many will sadly recognise.
As a former nurse who now represents patients injured by negligence, I’ve seen failings in care from both sides.
While medical injuries are often caused by human error, wider problems, such as chaotic wards, understaffing, miscommunication or inadequate supervision, play a part in most of the cases I see. I suspect the link comes as no surprise to nurses. When I was nursing, staffing levels were at times so low that providing an appropriate standard of care was challenging and at times close to impossible.
I think many of the Francis report’s recommendations have the power to make fundamental improvements, but the whole tone of the government’s response concerns me. While several good recommendations are being adopted, much focus has wrongly been put on compassion training.
“Being exhausted, undervalued and under-supported with a high ratio of patients to staff can make it difficult to provide the care people are entitled to expect”
Compassionate nursing is vital but, in my experience, student nurses already have compassion. Low wages and exhausting shifts hold little attraction unless you’re passionate about looking after people. The real issue is what leads someone who is motivated by kindness to treat a patient with neglect.
Being exhausted, undervalued and under-supported with a high ratio of patients to staff can make it difficult to provide the care people are entitled to expect. The want of anything close to compassion evident in some of the cases at Stafford Hospital was truly shocking, and perhaps politicians felt they had to create a headline-grabbing policy to address this, but it cannot work if the root causes are ignored.
The other risk is that the government’s plans may deter people capable of becoming wonderful nurses. Spending a year as a healthcare assistant before beginning a nursing degree should in theory create understanding for the caring role of frontline staff. Yet, to be effective, those who wash, clothe and feed patients must all be shown more respect and experienced nurses must lead by example, which will only happen if time is freed up and they are supported themselves.
One thing with the power to spark real change is the duty of candour recommended by Mr Francis. This would legally require staff to tell patients when a mistake is made. Being honest with families would allow lessons to be learnt faster and drive up standards. In Staffordshire management ignored patients’ complaints while local GPs and MPs failed to speak up. If the very first complaints had been taken seriously a great deal of pain might have been avoided.
While health secretary Jeremy Hunt says a legal duty of candour will apply to providers it is not, as yet, being extended to staff. I wonder how trusts can be entirely candid when health professionals don’t have to be. Yet, even at trust level, duty of candour may help foster a more open culture, which can only be a good thing. It has the potential to transform the way complaints are dealt with and reduce legal claims, as many patients simply want to see their concerns properly addressed.
The Mr Hunt says he wants the Francis report to become a “catalyst for change” not a “byword for failure”. It’s a bold ambition and duty of candour can only help, yet minimum staffing, communication, supervision and proper support are all vital. Clearly finances are tight, but austerity is no excuse for ignoring the correlation between understaffing and neglect.
Katy Meade is a clinical negligence solicitor at Mayo Wynne Baxter