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Francis Report - Opinion

Why are these failings happening?

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The reasons behind poor care are multi-faceted; however changes in the NHS and wider society may go some way to explaining the negative experiences of some patients

I have thought a lot about why poor care happens. It is a complex issue with no single and obvious cause or solution.

However, we can identify a range of factors that can lead to poor care such as the culture of an organisation, staffing levels, training and quality of leadership. In my view, looking for a simplistic “cause and effect” relationship is likely to give a distorted and incomplete explanation.

It is important to note that we are delivering care and treatment in a rapidly changing context. Our population is both growing and ageing and we are seeing an increase in conditions where age is a risk factor. While older people are living with long-term conditions such as diabetes, coronary heart disease and respiratory disease and living with cancer for longer, the pressure on resources is increasing.

We are also rightly seeing a rise in expectations from patients and increasing focus on enabling patient choice and self-management of long term conditions.

While the nature of the NHS continues to change, there has also been a change in how compassionate we are as a society, I can’t help but think we are experiencing a “compassion deficit”. We no longer demonstrate to one another those values of compassion and the importance of caring for one another and this will invariably find its way into the delivery of care.

Although there is no single factor leading to poor patient care, we do know that organisations with good patient satisfaction, good financial management, and low mortality have high levels of staff engagement.

We know that variations in patient experience are significantly influenced by staff work experiences in an environment where staff have high demands on their time and little control over how best to meet the demands of their patients.

This often creates a situation where staff distance themselves from the compassionate side of care as a means of self-preservation from the guilt, low morale and frustration of not being able to deliver care in the way they want – in many respects this is compassion fatigue.

The changing nature of the NHS and of society as a whole go some way to explaining the failings we have seen at Stafford Hospital and Winterbourne View. Although it is not always possible to identify one responsible factor, environments which encourage staff engagement appear to benefit from high-quality patient care, suggesting that perhaps this is where management should focus when looking to improve.


Steve Hams is Interim Director of Nursing, Cambridge University Hospitals Foundation Trust

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