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There is a tradition of romanticism when it comes to the NHS and often with good reason. At its best, it is a world-leading healthcare system. But the problems experienced by many patients at Mid Staffordshire NHS Foundation Trust, in one of the darkest episodes in its history, exemplified the very worst of the health service.
Revelations that as many as 1,200 patients could have died as a consequence of substandard care sent reverberations of shock across the whole country, forced patients to question how safe they were in hospital and fundamentally damaged public confidence.
The Francis Inquiry into Mid Staffordshire Hospital NHS Foundation Trust, the fifth major public investigation into the Trust, identified specific inadequacies within the Hospital Trust but, critically, also pointed to systematic failings across the whole NHS.
In the words of Robert Francis: “The system as a whole failed in its most essential duty – to protect patients from unacceptable risks of harm and from unacceptable…inhumane, treatment that should never be tolerated in any hospital.”
Widely regarded as a watershed, the Francis Report puts out 290 recommendations which he felt were needed to drive through a profound change in culture in the health service.
So what has the government done so far about Francis? Has patient safety really improved? And what can be said about public confidence in the NHS?
The government’s initial response, Patients First and Foremost, was promising. Agreeing to implement the Francis proposals, it set out plans to introduce three chief inspectors; one for GPs, one of hospitals, and one for social care. We welcomed this announcement and the fact that patients and their families were being encouraged to join inspection teams.
But on the whole we have been disappointed. Instead of moving quickly to implement the Francis recommendations, the government has dragged its feet. Rather than act decisively we have seen three further reviews: the Keogh Review, into 14 outliers for high mortality rates; the Cavendish Review, into regulation of healthcare assistants; and the Berwick Review into Patient Safety. All the reports have done is to confirm much of what we already know. The findings of the Keogh Review were yet another addition to the huge body of reports and investigations that have all identified the same barriers to the delivery of good care. The Cavendish Review said that healthcare assistants were performing the same duties as doctors and nurses but the notion of statutory registration was not even included in the terms of reference. Now of all times is not the time to play politics with patient safety.
At present, the future of the NHS looks turbulent. The NHS 111 non-emergency service, piloted in March was beset with problems from the very outset and full roll out of this service has been put back until 2014 with patients left in the dark. In a recent survey by the Patients Association, 76 per cent of those polled said they would not feel safe using their local out-of-hours service. A whole raft of evidence – from letters to the Health Secretary, to reports from medical colleges and statistical data – put beyond doubt, the fact that emergency departments are being flooded and they cannot cope with demand.
At the same time trusts are being asked to make £20 billion of efficiency savings. We have recently learned that the NHS is facing a budget shortfall of up to £30 billion by 2020 whilst the NHS management is hit by scandal after scandal.
What needs to happen?
Robert Francis QC has been explicit about what needs to happen. Those that run the NHS have to put the patient at its centre, involving them in service design and in decisions about their care. It needs to implement the findings of the Francis Inquiry, reform the ineffectual complaints procedure, ensure sound overall leadership and regulate Healthcare Assistants.
Finally the government needs to listen to the concerns of patients and professional groups and review the support being given to both the primary care sector and out-of-hours services.
The government’s patient safety tsar, professor Don Berwick, said that: “There is no reason why English healthcare cannot aspire to be and become the safest health care in the world.”
If the NHS really does have the potential to be the safest healthcare system in the world and if we want real improvements to patient safety, then health leaders must act decisively.
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