Nuffield Trust urges Government to avoid a ‘big stick’ approach when responding to the Francis report

Following the publication of the Francis Inquiry final report, we urge the Government to avoid using a ‘big stick’ approach when enacting the recommendations.

Press release

Published: 14/03/2013

How the Department of Health and Commissioning Board behave towards parts of the NHS following the Public Inquiry into Mid Staffordshire Hospital will be as important an indication of whether the culture of the health service is changing, as the recommendations that are eventually enacted.

In particular there must be no ‘big stick’ or punitive approach from the centre, as it would undermine the honesty and openness amongst staff that Francis recommends cultivating.

So argues the Nuffield Trust’s: The Francis Public Inquiry Report: a response, published today (March 2013).

Focusing on those areas where the Nuffield Trust has particular expertise, such as around NHS funding, patient-level data, commissioning and regulation, the paper strongly endorses the Inquiry’s main message that listening to and understanding patients must come first.

From a patient and family perspective, just one incident of poor quality care in any hospital can potentially lead to an irreversible, catastrophic loss, involving premature death or unnecessary suffering  Nuffield Trust Senior Fellow Ruth Thorlby

The response notes however that the Inquiry Report “alludes to, but does not develop, some important underlying tensions in the current system”.

Specifically, the candid and honest approach to quality recommended by the Inquiry may not sit easily with a more competitive approach to health service improvement, where hospital trusts are expected to compete with each other to attract patients, and economic success and failure are driven to some degree by patients’ and commissioners’ informed choices about where to seek treatment.

The question of how the Care Quality Commission (CQC), Monitor and other organisations choose to define and manage ‘failure’ in the NHS is therefore likely to be a critical issue, particularly if fundamental care standards were introduced which then raised the spectre of more hospitals moving into the ‘failing’ category.

Nuffield Trust recommendations for the Government to consider ahead of its own response to the Inquiry Report include:

  • Making the development of standards for the care of vulnerable older patients the first priority, as they are a particularly at risk group;
  • Giving responsibility for leading the development of fundamental, enhanced and developmental standards of care to the CQC (as an independent body) with participation from patients, health care staff, and other relevant stakeholders including NICE and commissioners;
  • Using NHS recruitment, induction and appraisal processes to promote the values of the NHS Constitution and to raise awareness of the document among staff, which is currently low;
  • Clarifying the regulatory arrangements for health providers – current documents such as the National Quality Board’s Quality in the New System do not sufficiently disentangle the complexity of current arrangements for monitoring the quality of care and financial robustness;
  • Enhancing the role of routinely collected, real time data, as a means of measuring care quality, informed by a range of organisations such as the CQC, the NHS Commissioning Board (now NHS England), NICE and other relevant organisations.

Commenting on the paper, Nuffield Trust Senior Fellow Ruth Thorlby said:

“What happened at Stafford Hospital was particularly shocking because of its unprecedented scale and duration.

“But, from a patient and family perspective, just one incident of poor quality care in any hospital can potentially lead to an irreversible, catastrophic loss, involving premature death or unnecessary suffering.

“It is ultimately the responsibility of boards to ensure their hospitals are providing high quality care for patients.

“But the Public Inquiry shows how difficult it is for providers, commissioners and regulators of health services to detect and respond to individual failures that might be occurring within one ward or department of an otherwise high-performing hospital, as well as identify and respond to larger-scale, more systematic failures of individual institutions.

“In part this is a technical challenge, based on how we use information better. But what the Francis report reminds us powerfully is we need a renewed focus on hearing and understanding what patients are saying.”

Notes to editors

The Nuffield Trust prepared a number of papers for the Mid Staffordshire NHS Foundation Trust Public Inquiry at the request of Robert Francis QC, covering matters including: the evidence on NHS commissioning; the regulation and training of NHS managers; the training and development of NHS boards; and the history and development of NHS organisation and management. Find out more and access copies of these papers

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