Future of NHS rests on wholesale shift to open culture

• Report: After Francis: making a difference
• Report: After Francis: making a difference (PDF 1.97MB)
• Inquiry: Report of the Mid-Staffordshire NHS Foundation Trust Public Inquiry
• Health Committee

Discussion of the Francis Report on the Mid Staffordshire NHS Foundation Trust public inquiry has tended to focus on the need for candour when things go wrong, but this is only part of the story, according to the Health Committee in a report published today

Commenting on this report, Rt Hon Stephen Dorrell MP, Chair of the Committee said today,

"The NHS needs to be an organization in which an open dialogue about care quality is part of the natural culture of the organization, not a duty which only arises in cases of service failure.

Robert Francis made 290 recommendations in his report, but in truth they boil down to just one – that the culture of ‘doing the system’s business’ is pervasive in parts of the NHS and has to change.

This cultural change will require a system where it is easier to raise a genuine concern about care standards or patient safety than it is not to do so. Many who raise their concerns in the NHS at present risk serious consequences for their employment and professional status. But disciplinary procedures, professional conduct hearings and employment tribunals are not the proper place for honestly-held concerns about patient safety and care quality to be aired constructively.

The NHS standard contract imposes a duty of candour on all NHS providers. This is an essential principle, but it is not adequately understood or applied. It should mean that all providers create a culture which is routinely open both with their patients and their commissioners. The same principle should apply to commissioners so that they are routinely open and accountable to local communities. The Health Committee recommended this approach in 2011, and we repeat this recommendation in this report.

Furthermore, we make it clear that we believe it should be a prime role of the CQC to encourage the development of this culture within care providers, and of NHS England to develop the same culture within commissioners. It is also important to ensure that any new statutory duty of candour is consistent with these broader obligations to patients, commissioners and the wider community."

In another development, the Report also announces that the Health Committee will in future work closely with the Professional Standards Authority to develop the accountability process for professional regulators in healthcare. Commenting on this development Mr Dorrell said:

"The professional codes of the clinical professions set out clear personal duties for all healthcare professionals and it is the responsibility of the regulators to ensure that these duties are reflected in practice. This process of professional standard-setting and accountability is the cornerstone of care quality; I welcome the fact that the Health Committee and the PSA will in future be working together to ensure that this key principle is developed and applied in practice".

In a wide ranging review of the Francis recommendations the Health Committee also concludes:

• Responsibility for monitoring patient safety data and practice should be transferred from NHS England to the CQC, and the National Learning and Reporting System’s classification of patient safety incidents in NHS-funded care should be applied equally to private healthcare and taxpayer-funded social care.
• Commissioners should require NHS care providers to provide data on staffing levels at ward level on a daily basis and publish it immediately in a standard format designed to allow easy comparison against benchmarks.
• Breaches of the proposed fundamental standards of patient care in NHS providers should be treated seriously and investigated thoroughly, but with regulatory consequences that are proportionate and focus on analysis and remedy of adverse circumstances that led to a breach.
• The responsibilities of the CQC and Monitor in operating the new single failure regime for providers will have to be very closely aligned. The Committee will examine proposals for the development of this regime with both regulators in their annual accountable hearings with the Committee.
• As part of its ongoing scrutiny work the Health Committee will continue to monitor and evaluate the Government’s response to the full set of recommendations made by Robert Francis.