Early thoughts on the Francis report published today

Well, it was incredibly thorough.  There were many more hard hitting recommendations than I’d anticipated and I’ll touch on a few that I think are really key.

Duty of candour

This is really significant in an NHS that in my experience has been focussed on the need to defend itself from litigation and complaint. The culture that this has engendered has meant that honest and transparent dealings with patients and their families are prevented by the need to avoid any acceptance of liability on behalf of the professional or the employer. This duty of candour should allow and promote the early acceptance of mistakes having occurred and therefore mean that the trust and relationship can be rebuilt quickly. This should improve health outcomes and mend the relationship between the public and the NHS because it allows for apology, a chance to make right what has gone wrong and diminish the need for patients to engage in drawn out legal battles to get to the truth. 

Registration of Healthcare Support Workers

I have spent many many days in my career with rooms full of staff who are delivering the bulk of direct patient personal care.  They are an intriguing and often inspiring group of people who have a clear thirst for knowledge and a true desire to meet the needs of and care for their patients. My experience of standing in front of 100s of Health Care Assistants at a time is that they want registration. They believe that this backed up with some minimum training standards, very clear clinical roles and a code of conduct will allow them to deliver care to the best of their ability and enable them to speak out when they know standards are not being met.

The merger of CQC and Monitor

For me this makes perfect sense. There is little objective reason for having two masters for a large number of NHS Trusts. The need to focus on care just as much as money is well articulated in the Francis report and having a single watchdog to monitor the NHS will allow this happen. The work by NICE on clinical standards and the need for NHS Trust Boards to publicly report on them will allow the Chief Inspector of Hospitals to lead this new invigorated organisation in ensuring that the failings highlighted in this report are much less likely to reoccur.

The Registered Nurse for Older Adults

This is a great idea and a potential solution to a very real problem in nurse education and post registration careers. Caring for older people, (just as for mental health or learning disabilities) can be seen as a real Cinderella career move. The nursing profession as it has become increasingly academic has had a focus on technical skills, such as nurse prescribing or minor operative procedures. Placing compassion at the forefront of nursing and the NHS as Francis aims today will allow the arguably more vocational caring side of nursing as is required in older people’s care to shine through in a newly designed role. The role is clearly about spending time with and caring for some of the most vulnerable members of our society. To help them eat, drink and understand what is happening to them with their health and social care whether in hospital and or the community.

I would be really pleased to receive your comments and I have extensive experience in all the above so please do contact me if you would like me to support you with reviewing your care and developing your care team.

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