The Francis report should be viewed as one of health service’s “brightest hours” rather than its darkest, according to the head of the Royal College of Nursing.
In an interview with Nursing Times last week, RCN general secretary and chief executive Peter Carter gave his initial reaction to the publication of the Mid Staffordshire Foundation Trust public inquiry report.
He said: “A lot of people have said it’s the NHS’s darkest hour. In many respects I believe it’s one of its brightest hours.
“What Robert Francis has done is open it up with these 290 recommendations – a whole raft of things – which I think will ultimately stand the NHS in very good stead.”
For example, Mr Carter welcomed the report’s recommendations on the regulation of healthcare assistants – of which the RCN is a long term advocate – the introduction of a legally enforced “duty of candour” to aid transparency and whistleblowing, and the strengthening of patient involvement.
Favourite Francis recommendations
Asked to identify three of the report’s recommendations that he would particularly like to see introduced, Mr Carter returned to Mr Francis’s call for HCA regulation and training, saying it would have a “massive impact” if introduced.
He also identified the report’s focus on strengthening trust boards and their responsibilities, which he described as “absolutely pivotal” for avoiding future service failures.
Lastly, Mr Carter said he “liked the idea” suggested in the report of creating a new specialist role for “older person’s nurses”.
“If you look at most of the critical reports, they time and time again relate to older people’s care. If we can do something to address that, it’s going to make a huge impact,” he told Nursing Times.
Minimum staffing levels
Mr Carter did not pick out the report’s recommendations for the National Institute for Health and Clinical Excellence to draw up minimum staffing levels to be policed by the Care Quality Commission.
But asked for his views on the recommendation, he said it “sounds strong”, adding that the college thought NICE had a “great track record” overall and had “stood the test of time” better than many organisations set up of the last 10-15 years.
However, he was less positive about the idea of performance-related pay for nurses and other NHS staff, which was described in the report and supported by prime minister David Cameron in his response statement to the Commons.
Mr Carter said: “I want to see the details. We’ve got the kind of headline, but now we have to wait till it drills down and say: ‘what exactly does that mean’.”
Defending the RCN
As widely reported, the RCN came in for specific criticism from Robert Francis QC.
His report described the college’s local representation at Stafford Hospital as “ineffective” and said there was an “inherent conflict” at national level between the RCN’s dual functions as a union and a professional body.
In the second respect, the report backed oral evidence given to the public inquiry by former chief nursing officer for England Dame Christine Beasley, who said “one of the things that we lack is an independent royal college”.
Mr Carter was robust in defending the college, highlighting that it was “not responsible for Mid Staffs”, and that attention focused on it by the national media needed to be “proportionate”.
He confirmed to Nursing Times there were no plans at this stage to split the college into a union and professional body. He said it would be “naïve” of anybody to suggest the failings at Mid Staffordshire could have been prevented if the RCN had been two separate organisations.
“The medical colleges are separate from the British Medical Association, and it didn’t stop the problems on the medical side,” he noted. “Why people could possibly think it would on the nursing side is beyond me.”
But he added “the right and responsible thing is to do is to examine it, and we will”. “There are over 290 recommendations, the right and responsible thing to do is look at all 290 and then in the fullness of time we’ll give our views,” he said.
Mr Carter acknowledged, however, that the college needed to instill in its local stewards the need to escalate concerns through the RCN hierarchy where needed.
“I am clear that things could have been done better. But I’m not in any way criticising the local steward.
“It’s a cultural thing… Our stewards are our backbone and they are brilliant, but we’ve got to be clear that if a steward ever feels that they are not getting somewhere it’s got to be brought up to the regional office,” he said.
Time to ‘move forward’
Mr Carter himself has previously been singled out for criticism from campaigners in Stafford, after he visited part of the trust in May 2008 and praised it in a letter to a local newspaper. The article was published on the same day that the Healthcare Commission wrote to the trust identifying serious issues.
“We’re quite clear that in the parts of the hospital where it was appalling, it was appalling. I certainly didn’t know about it – contrary to popular belief,” he said.
“Now what we need to do is move forward and prevent something like this happening again,” he added.