Wednesday, 6 February 2013

Grant Shapps plays politics with the Francis Report & should apologise.

The tweet above is Grant Shapps's response to the Francis Report. In the tweet you can see that he linked targets to "costing lives". This is not the conclusions reached by the Francis Report. In fact, if you click the link that Grant provides to David Cameron's words (in the tweet above), it does not even allege that Targets cost lives.  Page 1,348 of the Francis Report categorically states

The Francis Report clearly states that considerable benefit gain be gained from targets, and that they serve a useful purpose and can be an "important" part of the health system. I would suggest that Grant withdraws his statement and reconsiders.  The Francis Report in so far as it apportioned blame placed responsibility with the Trust Board. Your reporting of the Francis Report gives a distinctly different impression.

My own response to the Francis Report can be read (here).

Today, Robert Francis has published a comprehensive report into the Mid-Staffordshire Hospital Trust that you can read for yourself by following this link (here). I wholly welcome the report, without reservation, and call upon David Cameron to implement its findings in full.

The most urgent changes required are significantly enhanced whistleblower protection. Francis is right to state that “So called gagging clauses should be banned”. At the minute knowledge of wrongdoing is one of the most dangerous burdens for staff to carry, and staffs are terrified of having their character assassinated, or their livelihood destroyed if they speak out. Francis’s recommendation that the CQC & NMC work more closely together would definitely be a step in the right direction, especially Francis’s insistence that the NMC should be more pro-active in commencing investigations without need for referral. Francis is also right to point out the pressure the CQC is under. More than 20% of its staff has been axed in 2 years, and as Francis writes “it [CQC] is not a happy environment” to work in. The government needs to restore the funding and staffing cuts to the all-important CQC.

In addition, we need a full inquiry into down banding and deskilling currently occurring in our NHS. Too many experienced staff are either being axed, or having their duties and role down banded to save money. All too often, experienced nurses are being replaced with Healthcare Assistants. This is dangerous. Already some NHS Trusts have HCA ratios of 40%. The Francis recommendation that “Each patient should be allocated for each shift a named nurse responsible for coordinating provision of care for each allocated shift” is totally correct. Francis also explicitly, and rightly, states that HCA staff should have more consistent training. At the minute there is nowhere near enough.

We currently have a shortage of Registrars and Matrons in our NHS. Despite promises by politicians to recruit them in greater numbers it simply has not happened. We need to ensure adequate staff of high expertise is recruited, especially to cover out of hour shifts.
The horse has bolted, but the Foundation Trust model is dangerous because it puts hospitals in direct competition with each other. The last two governments deserve blame for perpetuating the FT structure. The bottom line for Trust managers will always be financial viability as long as the model exists, and this cannot ever be to the benefit of the patient especially in terms of staffing and bed ratios. Sir Robert Francis is totally correct to conclude that business was put before patients.

Tories have alleged that successive Labour Ministers ignored advice that if followed would have led to safer outcomes. Today, the Francis Report rules that out by explicitly stating there is "No evidence any Minister received or ignored advice that would have led to safer outcomes". See page 1,265. Sir Robert Francis also insists that “"No criticism of the conduct of any Minister is intended in this report's findings."

Prior to the publication of the report the Tory Party spun that a “tick box” culture was to blame. But contrary to Govt pre-spin the Francis Report explicitly doesn't blame targets See page 1,348 where Francis explicitly states that “Targets "provide considerable benefit & serve useful purpose [...] can be an important part of the health system."

Once again, let me commend this report. Lessons must surely be learned by all involved in the NHS from top to bottom. Francis is right to call for better training for staff, better whistleblower protection, better expertise and recruitment. The CQC deserves to have its funding cuts restored. I hope these are the lessons ministers learn from the Francis Report. 

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