After the Francis Inquiry: are we more aware of care quality?

When opening the Nuffield Trust Francis one year on conference, Rt Hon Stephen Dorrell MP described the second Francis Inquiry Report as a ‘seminal event that needed to become a transformative one’.

The Nuffield Trust report: The Francis Report: one year on states that hospitals have taken significant heed of Francis, and have focused in many and varied ways on care quality, compassion, complaints, nursing and openness and transparency.

It also finds that hospitals feel the rest of the system, including commissioners and regulators, appear to have changed very little. These bodies were not part of the research, and may feel differently, but the perception of a blaming approach to achieving targets and standards is still present.

I had observed that our policy of openness must extend to sharing with the public the need for future service change

Rt Hon Stephen Dorrell MP also debated the role of professionals in improving quality and the notion that they might be driven by ‘divine discontent’. He emphasised too the necessity of creating a culture of quality improvement, because ‘you never inspect quality into anything, (it) is not the answer’.

We heard from two (Heart of England) nurses who spoke movingly about how nurses felt following the Mid Staffordshire NHS Foundation Trust publicity, and how they were now challenging each other over care standards, such as the notion of ‘unavoidable’ pressure ulcers.

The regulators who spoke at the conference were keen to stress they were changing. Niall Dickson of the General Medical Council felt they were ‘on the pitch now’ and closer to the front line through involvement in training and revalidation.

Kate Moore of Monitor noted their greater awareness of quality issues, and reminded the audience of David Bennett’s recent comment that the ‘arm’s length (of Monitor) is now a little shorter’.

Robert Francis QC said we had made ‘a good start, but there is more hard work to do’. Judging by the reaction on Twitter, and coffee time conversation, many were wondering how financial constraints might affect progress.

Francis pointed out that compassionate care does not need to cost more. Interestingly, he went on to say that ‘if cost constraints really prevent achievement of proper standards, then better not to provide the service at all’.

Fascinating stuff! Earlier, I had observed that our policy of openness must extend to sharing with the public the need for future service change. It is likely that the requirement for quality improvement, and seven day services with appropriate staffing to support these, will necessitate some service rationalisation. If so, we need to start an honest conversation soon.

Now there’s a challenge, and one we could follow up when we meet again, two years after Francis!

Dr Mark Newbold is Chief Executive at Heart of England NHS Foundation Trust. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.