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Will Francis rise again?

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On The Pulse is a weekly round-up of what’s happening in nursing or an analysis of a key nursing issue, written by Nursing Times staff. This week: practice and learning editor, Ann Shuttleworth

In early 2013 the entire nation was stunned by the grim findings in Sir Robert Francis QC’s long-awaited report into care failings at Mid-Staffordshire Foundation Trust.

Stories of patients left lying in their own faeces or so thirsty they drank from flower vases were accompanied by 290 recommendations covering all levels of healthcare policy and practice.

While Sir Robert’s inquiry was the most detailed in recent years, reports by organisations such as the Care Quality Commission the Patients Association and the Health Service Ombudsman underlined the fact that Mid Staffs was not on its own. Although the vast majority of NHS patients received excellent care, for a vulnerable minority it was nothing short of catastrophic.

”Although the vast majority of NHS patients received excellent care, for a vulnerable minority it was nothing short of catastrophic”

Radical action was needed across the whole healthcare system.

For a time it seemed like Mid Staffs would be the catalyst that transformed healthcare. Unlike so many reports from previous inquiries and Royal Commissions over the decades, this would not be filed away and left to gather dust – from central government down to frontline care, everyone was galvanised to do their bit to make sure nothing like this could happen again.

For the nursing profession probably the most welcome post-Francis change was a general acceptance among those who held NHS purse strings that the ratio of registered nurses to patients had a huge influence on care quality and patient safety.

Evidence that fewer nurses led to increased mortality and reduced quality had been largely ignored or dismissed, but was suddenly taken seriously – safe staffing was top of the agenda.

”Everyone was galvanised to do their bit to make sure nothing like this could happen again”

So three years on, why does it feel like we are returning to the bad old days before Sir Robert lifted the lid on healthcare provision?

Only last week alarms were raised about two providers – one serving the same population as Mid Staffs – that sounded depressingly familiar.

North Staffordshire Combined Healthcare Trust was given an official warning by the Care Quality Commission that its child and adolescent mental health community services were ‘inadequate’ and that staffing levels were ‘not safe’.

Meanwhile, Liverpool Community Health Trust was heavily criticised for pursuing aggressive savings and foundation trust status – exactly what had led to most of the problems at Mid Staffs. The report described an oppressive culture in which staff were being driven to the brink.

Ever heard anything like that before?

”Why does it feel like we are returning to the bad old days?”

With budget overspends, recruitment problems, agency spending caps and a rowing back by NHS England on earlier support for safe staffing guidelines it’s starting to look like the NHS has come full circle.

We’re in danger of returning to the short-termism of the pre-Francis years, where nursing posts are left unfilled to save money, then overworked nurses are lined up to take the blame in national media when patients and their families receive substandard or even dangerous care.

Patients were promised that Mid Staffs was a turning point and such a situation would not be allowed to happen again. Let’s hope government ministers and NHS managers dust off their copy of the Francis report over Easter and remind themselves why they made all those promises three years ago.

If they don’t, Sir Robert may find himself called in to investigate the next Mid Staffs.

 

 

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