David Behan (Care Quality Commission), Jill Maben (King’s College London), Harry Cayton OBE (Professional Standards Authority), Professor Sir Ian Kennedy (former chair, Healthcare Commission) and Peter Walsh (Action against Medical Accidents) give their reactions to the Francis Inquiry report.
This was recorded during our 2013 Francis Inquiry conference.
1. Prof Kennedy is right to identify politics as an issue but reflects his own bias by adding more weight to the need for further ill thought out and unproven reconfigurations. Instead we should be listening to patients not professional doctors interests. Patients dont want reconfigurations. By all means improve care in the community but until such time as it is proven to work (and the evidence to date doesn't prove this) as a substitute for hospitals then adequately staffed and equipped hospitals should be supported not undermined. Britain doesn't have enough hospital doctors and yet the answer from the doctors is always to keep numbers down. Those few patients requiring specialist care should be focussed on fewer centres but the vast bulk of care, including A&E, maternity and paediatrics needs to be local.
2. Dr Dan Poulter MP should be ensuring there are enough junior medical staff to ensure availability of doctors in hospitals. Instead he is planning to reduce numbers. How does he think this will improve quality of care?
3. The insularity of the discussions was interesting. The numbers of excess deaths postulated by Francis is by no means substantiated.
Who says the average in the NHS is the standard which should be aspired too?. International comparisons of infant mortality, deaths from cancer , stroke, and other treatable diagnoses all reflect poorly on the NHS. I await the outcome of the report on the 14 other hospitals with high mortality rates. The liklihood is that poor care will be identified in many other places. But it is the average hospital we should be concerned with and without reliable ,timely international measures of comparative performance unwarranted assurance may be being unwittingly provided by applying national norms.
4. There was no mention of the role of litigation. Until there is an unequivocal, enforceable right to healthcare and a right to compensation in the event of harm being done we will continue to see a culture of delay, dilution, deferral and denial as patients struggle to get access to healthcare and then in the event of harm being done acknowledgement and appropriate compensation. While poor care saves money we should expect more poor care. The patient badly treated needs to be a cost to the system.
By all means try to reform hearts and minds but in the end incentives and penalties have the most impact.
Where were all the doctors??
This level of disengagement has been brought about by several factors:
1. Persistant re-organisation of the service which has engendered change weariness in consultants and a sense of 'can't be bothered with it'
2. An inane target driven culture that consultants see as largely as nonsensical and often detrimental to quality care
3. The rise in the authority of other healthcare professionals who have been allowed to take over the management of patients, often in a way that conflicts with the consultant's opinion (look at the ordering of operating theatre lists for example)
4. The demise of the old clinical firm structure that gave the consultant ownership, authority and governance over the delivery of healthcare on the wards by trainees (partly annihilated by european regulations)
In my opinion, you will never engender a change in ethos and culture in the delivery of healthcare without 'buy in' from consultants, and there is no sign of the system allowing them to do so at present.
Put the consultants back in the driving seat of secondary care, in the same way the the GPs are in the driving seat of primary care with overall ownership of the management of their patients, and see the difference in quality that will ensue. Look at the model that exists in independent hospitals where consultants are still have control of the management of their patients, and where the quality of care is simply better as a result.
I hope Dr Poulter thinks this one through!