Francis report: key lessons to be learned

The publication of the long awaited Francis report1 on the disastrous events at Mid Staffordshire NHS Trust must surely have been read by now, by everyone working in healthcare. The voluminous report (even the summary runs to more than 100 pages and contains 290 recommendations) clearly analyses the systems failures which the chair of the inquiry has established led to appalling suffering, horrific patient experiences and unmitigated failings of compassionate and dignified care for patients over four years in the hospital. The organisations named for a variety of contributory aspects are almost without exception making detailed analyses and consideration of their responses, at the time of writing. There is a great deal of comment still to come. There are few of the organisations with monitoring and regulatory roles who do not come in for variable degrees of criticism from the Inquiry with recommendations as to change and future actions, to prevent the recurrence of such a catalogue of disasters. One of the overarching findings is that many of these organisations, tasked with an overview and strategic role for quality and patient safety such as the National Patient Safety Agency, the Care Quality Commission and Royal Colleges, did not speak to each other about their known concerns. They continued to act in isolation and thus many of the possible early warning signs were repeatedly missed. These were the external organisations, among many mentioned – but what of the internal frameworks for clinical governance, professional responsibility for reporting areas of concern and management of complaints? Why were these also ignored with regard to signs of failure and poor patient care? Francis reports that the hospital board and responsible executive members were entirely focused on achievement of financial and Government targets in order to achieve Foundation Trust status. They had very poor awareness of clinical care and apparently turned a blind eye to complaints, high infection rates and other factors within the hospital which might have signalled that all was not well. There was an organisational culture of bullying with many professional staff being threatened with dismissal if they failed to achieve the targets set or hinted at the delivery of poor quality care. In some instances where comments were made, they were ignored by those who had any authority to make changes or adjustments. One important aspect of the culture in the hospital that should ring some alarm bells is that the hospital and the NHS was, at the time, under significant pressure to make financial savings – which had reduced the staffing in significant numbers so as to be deemed unsafe in some ward areas. We must not let this situation happen again, in the current climate of austerity and financial pressure on the NHS. There are many questions arising from the report – not least, how can the situation be prevented from recurring and what are the key lessons that may be learnt for the future?

Impact on clinical practice

The main impact on clinical practice must be to listen to patients, to include them in every aspect of their care and to show compassion and respect for their views. Many of the reports which have come to light in the last few years have highlighted the same failings and it is time that all clinical staff identified where care has to improve. The Patients Association launched with the Nursing Standard,2 a CARE Campaign in November 2011 which is based on the four most frequent concerns heard by the Patients Association from patients, relatives and their carers:
C – Communicate with compassion.
A – Assist with toileting, ensuring dignity.
R – Relieve pain effectively.
E – Encourage adequate nutrition.