Why wait for the Francis report? Here are 10 things to do now

Whatever happened to patient safety? Throughout the government’s reforms, and despite the challenge created by its abolition of the National Patient Safety Agency, this has been one of the quietest areas of policy discussion.

Is that because, for a large part of 2012, national organisations have sat with their feet braced against the collision expected from Robert Francis’ inquiry report into Mid Staffordshire Foundation Trust?

This report, covering everything from board reorganisation to frontline care to regulation, has been looked to for the “next set of instructions” on how the system should manage safety. But “waiting for Francis” has become like waiting for Godot − anticipated publication dates in April and October have now come and gone.

We need a concerted drive towards creating an open and compassionate culture in all care providers

To fill the gap, National Voices, a coalition of health and social care charities in England, has released its own “not the Francis report” urging an end to the paralysis. Evidence is mounting of systematic deficiencies in the way our services are designed and run − and we already know what to do about most of these.

Key actions

Indeed, the NHS Confederation has welcomed our report, stating that what patients want is also what NHS leaders want. So here are some thoughts on the top 10 actions that can be taken now.

• This year’s review of the NHS constitution shows it has had too little impact. We need a concerted drive towards creating an open and compassionate culture in all care providers, underpinned by accountability for upholding the NHS constitution.
• The constitution’s “pledge” towards openness when things go wrong is too often dishonoured by a defensive NHS. We must go further and have a statutory duty of candour.
• “Listening to patients” has already been a theme of earlier reports into Mid Staffordshire and will surface again. It is time to revive the ambition of NHS trusts having systematic, comprehensive and frequent patient experience measurement − with results reported at all levels of management. This is primarily for quality improvement but means poor care will have no hiding place. Northumbria Healthcare NHS Foundation Trust is a pathfinder here, receiving 25,000 patient views a year. The crude “friends and family test” is a backward step for trusts like this, and should not be relied on by the NHS.

It is time to invest in patient leadership as we do in managerial and professional leadership

• The new duties on commissioners to promote the involvement of each patient in decisions should be the start of a concerted effort to stop talking about the “no decision about me, without me” slogan and start delivering it in frontline services.
• Patients can be leaders, too, supporting other patients and service users, speaking out on their behalf, and helping to design services and hold them to account. It is time to invest in patient leadership as we do in managerial and professional leadership.
• Some hospital services need radical reorganisation, where safety and quality demand a greater concentration. The NHS has a poor record when it comes to making a good case for change, involving communities and winning support. Some important changes have been ducked for decades. National Voices has agreed to work with key system leaders on a methodology for doing this well, ensuring communities have a voice and that concerns are properly addressed.

Bringing managers or healthcare assistants into regulation would be a wrong-headed response

• Within hospitals, urgent work is needed to ensure that safety and quality in hospitals do not vary according to how old the patient is or when they are admitted. The current variability is unethical and scandalous. Trust boards should be held accountable for how well they reduce these gaps. Action is needed to implement the recommendations of the Royal College of Physicians’ Hospitals on the Edge report, to improve continuity of care within hospitals; and the Delivering Dignity agenda
• Making hospitals safer also requires an uplift in the quality and organisation of out of hospital care. Coordinated care (integration) is a must-do. We need to establish high-quality full-service, community-based care. The key elements are: preventive services; care planning and named care coordinators to help vulnerable people to live well and avoid unnecessary hospital admissions; and joining up health and social care services. Good out-of-hours care and round the clock crisis support are essential.
• Implement Dilnot. Enough said.
• Do not focus too much on extending regulation. It has an important but limited role. Bringing managers and/or healthcare assistants into regulation would be a wrong-headed response.

Let us not keep repeating the Beckettian dialogue: “Let’s go.” “We can’t.” “Why not?” “We’re waiting for Francis.”

Don Redding is director of policy at National Voices

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