Tuesday 26 March 2013

Will the Francis report make a difference to the NHS in the long term?

Will the Francis report make a difference to the NHS in the long term?: Those working in the sector must accept that the report alone will not be enough to stop the failings in the short term.

Despite calling for far-reaching changes, the Francis report will not be enough to stop failings in the NHS in the short term and only time will tell if its recommendations will make a difference in the longer term. In the meantime, there is a real risk that some patients will continue to receive substandard care.
This is an unpalatable truth, but it is one those working in the sector must accept. While the vast majority of doctors and nurses will have the best interests of patients at heart, there is no hiding from the fact that their working conditions are extremely difficult. A combination of budget cuts (leading to understaffed wards and poor and inadequate training and supervision), a strong emphasis on meeting targets and managerial constraints have made it extremely difficult to deliver safe, dignified and compassionate care.
There is unlikely to be any quick fix. In his examination of the quality of care at Stafford Hospital in 2005 to 2009, Robert Francis QC highlights the need to address a "culture of fear" in the NHS and calls for a duty of openness and candour. NHS organisations have been told in no uncertain terms that it is not acceptable to suppress complaints or attempt to sweep sub-standard practice under the carpet. If this recommendation to introduce a legal duty of candour is realised, it would be a significant step, which would almost certainly result in real improvements in patient care. The call for openness is to be welcomed and must now be heeded.
Any move to address this will require a cultural shift for staff working in the NHS where there has always been a deep-rooted fear associated with whistleblowing and speaking openly about concerns in patient care. In 1990, Graham Pink, a nurse, was fired for highlighting his concerns with regard to inadequate care of the elderly on a geriatric ward he was working on. However, it is only by being open and honest about concerns over patient care that problems will be identified and tackled, and standards improved.
It is a shame that the report's recommendations are unlikely to bring about positive change quickly. Inundated and understaffed organisations are already struggling to cope with further structural changes and the need to deliver budget cuts. Without additional funding to pay for more staff, appropriate training and better and increased supervision for staff, it is difficult to foresee how improvements can be made.
In the short term, this may mean that patients continue to suffer unacceptably at the hands of doctors and nurses who are trying to do the best they can with the very limited resources that are available to them.
Caroline Klage is a partner and medical negligence expert at Bolt Burdon Kemp. Guardian Professional. 

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