What next for the NHS after the Mid Staffs scandal?

What next for the NHS after the Mid Staffs scandal?:

We round up readers' thoughts on the direction of the NHS after the Francis report, following an online live discussion

Whistleblowing and a duty of candour

Jon Restell: "Whistleblowing is a bad safety net – it runs counter to human nature to expect people to routinely demonstrate the courage to risk their careers and livelihoods (and more pertinently the welfare of their families) to right the wrongs of a system. Only an open safety culture will support people to speak up and talk about harm that others are doing."
Jo Webber, head of policy at the NHS Confederation: "The duty of candour is an important step forward in changing a culture that in the past has been too quick to close down issues rather than really work at learning from them. Both a whistleblower and their manager would have an obligation to follow through on officially raising concerns."
Judith Smith, head of policy at the Nuffield Trust: "A duty of candour could provide important support to managers themselves in reporting problems and bad news – the culture of the NHS has, as Francis notes in the report, been too much focused on claiming success and progress, and not enough on the acknowledgement of problems and mistakes."
Carl Macrae, senior research fellow at the Centre for Patient Safety and Service Quality at Imperial College London: "Other industries – aviation in particular – have for a long time required "mandatory" reporting of safety issues, with strong regulatory backing, whilst maintaining a just and fair culture around safety incidents."

Regulation of managers?

Jan Sobieraj, managing director of the NHS Leadership Academy: "I don't think putting managers on a register or list somewhere will lead to the changes we need to see."
Chris Hopson, chief executive of the Foundation Trust Network: "We have to think about the role that the trust board plays – the board has to be ultimately accountable for the delivery of safe and quality care in its trust and I'd want us to think carefully about how regulation of managers interacts with this."

The future of David Nicholson

Jon Restell, chief executive of Managers in Partnership: "I don't think his resignation would change what needs to be changed. The calls for his resignation are understandable – and the bewilderment of the public as to why no one appears to be accountable is something we should address in this discussion – but one man has not created the culture of the NHS and one heroic leader will not change it."
Julie Bailey, founder of Cure the NHS, a patient group set up to raise concerns over Mid Staffs foundation trust hospital: "We feel that without accountability within the NHS now nothing will ever change, regardless of the recommendations. We are not looking for scapegoats but believe that those responsible for this disaster and have failed need to be held to account."

Accountability of the Department of Health

Chris Hopson: "Most government departments understand that their role is to design and oversee the system – ensuring that they have the right regulators, the right public service delivery structures and appropriate protection of service for citizens. One of the very noticeable things about the old DoH was that it tried to do all of these. There is now much greater clarity that its main role is to design the system and oversee it."

Regulation

Peter West: "It seems that the minister wants to keep Monitor but personal experience has shown me how turf wars develop – ie between Monitor and the Healthcare Commission. They could not even agree on how many categories to include in their ratings at one stage. I would vote for one regulator every time."
Jon Restell: "Too much regulation is incoherent, burdensome and undermining of the very care standards it seeks to promote. It has to be the right mix of not trusting and trusting, and better and simpler."
Jocelyn Cornwell, founder of the Point of Care programme at the King's Fund: "The main obstacles to regulators sharing information were not the people, it was that each organisation is set up with different rules and statutes, and sometimes with overlapping roles, and it's incredibly hard to work out how to co-operate well together. I don't think merging CQC and Monitor will help."
Jules Acton, director of engagement and membership at National Voices: "If I had a few millions in my pocket to spend on the NHS I wouldn't be investing in more regulation. Regulation is important but it can only go so far. Inspectors can't be everywhere all the time, but patients can and are. I'd spend it on getting good quality feedback and acting on that feedback."

Workforce

Darren Whitehouse: "The Francis report talks about competence, but in our experience, most discussions and training around competence focus on knowledge and skills and little consideration is given to the attitudes and behaviours that are also a key element of a competent person."
Elliott Westhoff: "In one trust I have worked at they have introduced an excellent 'Living the Values' training programme, which has a strong focus on attitude and behaviour. Each member of staff makes a pledge of something they will do differently or more of in their daily work life that aligns to the trust values."
'SquirrelCody': "If care workers were on a register they could be regulated – just as nurses are. Care workers can currently move from one job to another irrespective of performance, especially those working for agencies. They have no code of conduct to follow."
You can read the original online live discussion in full online here. Guardian Professional.