Does Francis ignore the health services “4 Horsemen of the Apocalypse”: what does this mean for the modern NHS?

Abstract

The recent Francis report has spotlighted poor standard of care at Mid-Staffordshire NHS Foundation Trust in the UK. It asks how this could have happened in a hospital with internal governance mechanisms and regular review from a plethora of external regulators. It further asks who is responsible and accountable for this failure. The report also underscores a widely held anxiety that “mid Staffs” is not unique and such catastrophic failures in care could, and will happen again despite more enhanced regulation and scrutiny. The unasked question in the report is fundamental and revealing. WHY did this happen? This does not require a detailed understanding of the regulatory mechanisms which were designed to detect fault, but rather what was the underlying cause of these often basic care failures. The thesis of this article is that four fundamental changes - 3 in the elements of service delivery and 1 in the requirements for care - have conflated to create a major problem and a service which is unable to face the demands that will increasingly be placed on it. The solutions to this current dilemma require acknowledgement of these issues and transformational changes in the way we think, work and deliver healthcare.