Tepid Francis response won’t guarantee patient safety

This isn’t the NHS or even the “new” NHS. It’s the new transparent and accountable NHS. That was Jeremy Hunt’s message when he responded to Robert Francis QC’s report into the Mid Staffordshire scandal.

‘The problem with accountability is that it’s retrospective. Something has to go wrong for anyone to be accountable’

Mr Hunt claimed that cruelty has become the “norm” in the health service but no one had noticed. So it was time to right the wrongs and ensure failings like those at Mid Staffordshire could never happen again.

That meant accepting the majority of Francis’s recommendations, including a duty of candour for organisations, a requirement for hospitals to publish nursing numbers, hospitals facing financial liability for errors that occur under their roofs, a fit and proper persons test for managers and the introduction of care certificates for healthcare assistant.

The problem is that Mr Hunt did not go far enough, and the result is that for all the new demands on the NHS, and particularly acute trusts, patients are unlikely to be much safer.

There is nothing wrong with requiring hospitals to publish reports on how they are handling complaints. It’s entirely correct that wilful neglect should be a criminal offence. We can debate the rights and wrongs of hospitals shouldering financial liability for mistakes. These measures may result in greater transparency and accountability. But the problem with accountability is that it’s retrospective. Something has to go wrong for anyone to be accountable.

Gaping holes

So while these measures are important, of greater interest is what going to prevent incidents happening in the first place.

‘The government’s plans do nothing to change the lack of oversight for unregulated healthcare professionals’

This is where the gaping holes in the government’s approach appear, because the Department of Health has taken the decision not to adopt some of Francis’s recommendations in full, has ignored others entirely, and has completely failed to deal with wider issues of oversight of the NHS workforce despite many of its members remaining unregulated.

There was no introduction of a duty of candour for individuals, only one for organisations. So there was no emphasis on the responsibility of individual healthcare professionals to report poor patient care or threats to patient safety.

There was the introduction of a “care certificate” for healthcare assistants that fell short of the registration proposed by Francis. And there was not the faintest indication that the government had seriously considered the concept of a single regulator to ensure clarity for patients and their families needing to raise awareness of quality of care.

Major upheavals

Granted, the movement to a single regulator would have been a major upheaval within an NHS that is still adjusting to the last reorganisation. This is not to suggest it would have been a silver bullet that would cure the NHS of mistakes and malpractice, and would guarantee the safety of every patient that comes through the doors of a hospital.

What it could have done is provide a simpler, easy to navigate system for patients and their families needing to report concerns. It could have given the government’s efforts at accountability some teeth. It could have improved communication and prevented malpractice and incompetence slipping through the cracks of a fragmented system in which various sections of the workforce have their own regulators.

And it could have brought the unregulated sections of the health service workforce under its auspices, particularly those working directly with patients and undertaking investigations or procedures with the ability to cause harm.

‘We are left with the same complex and fractured network of health regulators that many healthcare professionals struggle to navigate’

This isn’t what we have and, particularly as the government’s plans do nothing to change the lack of oversight for unregulated healthcare professionals, it is a struggle to see how patients will be better off and better protected.

There is a worrying pattern in the government’s behaviour in that ministers seem unwilling to take all of the necessary steps to ensure there is the oversight in place in the form of regulation to compel the levels of openness and transparency they seek.

What are we left with? The same complex and fractured network of health regulators that many healthcare professionals would struggle to navigate, let alone a patient or family at a time of crisis and stress. A raft of ineffectual voluntary registers, managed through a fundamentally weak process of “assured voluntary registration”, for unregulated professionals that despite their best efforts lack the resources or authority to identify and deal with incompetence.

Missed opportunity

There was an opportunity to make sure the Mid Staffordshire inquiry was a watershed and that, while there have been other scandals at other trusts since, the right steps were taken to ensure it could never happen again.

By failing to implement Francis’s recommendations in full and by ignoring unregulated healthcare professionals almost entirely, the government has missed that opportunity.

Forcing trusts to be more open and accountable is laudable, but without steps to compel personal responsibility and enable the enforcement of professional standards it might be for naught. A Mid Staffordshire scenario might not happen again. It should have been nearly impossible.

Anne Burge is chair of the Alliance for Patient Safety