The Francis Report: my priorities

Abstract

At last we have the Francis Report, the reaction to events at the Mid Staffordshire NHS Foundation Trust, chaired by Sir Robert Francis QC. Published on 6 February it has been long awaited—too long some might say— given the horrendous events that led to it. While I appreciate many of you may not have read through 1 700 pages, I hope you are at least familiar with it. I also hope the harrowing stories of failures in patient care stick in your mind, whether it is because you have read them in the report or heard relatives in the press, still understandably upset several years after the events. There are 290 recommendations in the report. Many are specific to the NHS in England. Others are relevant to all health professionals and organisations. While I find little to disagree with in the generality or detail of the recommendations, I doubt they will all be implemented in full. We need to wait to hear the responses of national governments about implementation in the four UK countries. We also need to take some time to consider the recommendations in the context of our own organisations and professions. However, we must not take too long and we must see some decisive national action or we risk even further damage to public trust and confidence in the NHS. For nursing there is much to consider in the Report—too much to consider here—but I want to share some of the highlights that matter to me. A lack of professional accountability is highlighted throughout the Report, as is a lack of caring and respect for older people. Poor and harmful care and conditions were accepted in Mid Staffs and patients and their families suffered terribly because of it. A few nurses tried to report the problems but were ignored, or bullied and harassed. When we register as nurses, we agree to uphold our Code of Conduct, however, my experience is that few nurses ever refer to it again, unless they are caught up in some disciplinary process. We should use The Code more proactively through training and appraisal, creating space for a two-way dialogue about near misses by the individual and the organisation. Of course organisations must play a significant part in enabling staff to be accountable. Giving real opportunity and support for individuals to raise significant concerns is something most organisations say they do, but being able to raise the little things matters just as much. I have noticed an increase in concerns bought to the attention of myself and other senior colleagues recently. This is most welcome, whether it is via formal incident reporting about staffing levels or a shortage of equipment, thoughtful correspondence about system-wide Melanie Hornett Nurse Director NHS Lothian Health Board clinical governance issues, a quick chat in the corridor or a text message about ward curtains or patient transfers. All this information means we can work together to resolve issues and keep patients safe. The more examples staff can see of action following the raising of real concerns, however big or small, the more likely they are to do it again and, more importantly, encourage others to do it. We also need to be able to share concerns with colleagues more easily and deal with some on the spot. Positive peer pressure is one of the most powerful change agents we have and is crucial in establishing and maintaining a ‘culture of caring’. Such a culture is vital for all patients and staff but particularly those patients who are most vulnerable; the very old, the very young and those with mental health needs or learning disabilities.