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'Patients matter most but staff matter too'

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The revelations of the Francis Inquiry into care at Mid Staffordshire hospital two years ago made shocking reading. How could something like this happen in our NHS?

Today Sir Robert Francis sought to answer this in the Freedom to Speak Up Review, which explores the problems staff experience when they want to raise and escalate concerns. While reading through the summary of the report I was reminded of a quote from Marie Manthey, a pioneer of the primary nursing movement, which captures simply what our priorities should be:

“Patients matter most but staff matter too”

What Sir Robert has demonstrated is the difference between a culture that nurtures staff and one that sees both staff and patients as commodities who can be pushed through systems based on industrial processes rather than the principles of humanistic care.

It is difficult to read Sir Robert’s account of talking to people who tried and failed to raise concerns in organisations designed to care. He says:

“It is difficult to read Sir Robert’s account of talking to people who tried and failed to raise concerns”

“The genuine pain and distress felt by contributors in having to relive their experiences was every bit as serious as the suffering I witnessed by patients and families who gave evidence to the Mid Staffordshire inquiries. The public owe them a debt of gratitude in the first place for speaking up about their concerns, and secondly for having the courage to contribute to this Review”.

There are 20 recommendations, which have all been accepted “in principle” by Jeremy Hunt, but my concern is how these will be implemented. I can already see chief execs reaching for a pad trying to work out a to-do list, but as Sir Robert makes clear:

“We need to establish everywhere a culture in which all staff feel safe to raise their concerns.”

My concern is that while we talk a lot about culture and openness and honesty, this winter we have seen meltdown in many parts of the NHS. There has been a mantra in the NHS over recent years that you don’t need more money – you just need to do things differently. But the winter crisis in A&E has indicated that many NHS organisations have been pushed as far as they can go.

“Francis has laid out a framework for ALL staff to raise concerns”

Nurses struggle day in and day out to provide the bare essentials of care to patients. They are forced to cut corners and compromise because they have neither the time nor the resources to do otherwise.

Yes, NHS managers need to facilitate a cultural change that allows staff to raise concerns. But in return these managers need adequate resources so they can support their staff to do the best job they can.

Francis has laid out a framework for ALL staff to raise concerns. Politicians now need to be ready to deal with the reality of providing care in a service that is underfunded and run on the goodwill of staff.

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