Editor's Comment

Safety first

There are many competing priorities and worries for NHS executives to juggle at the moment, not least since the Francis report (and its 290 recommendations) has landed just weeks before the formal transition to new commissioning and regulatory structures under the Health & Social Care Act.

Both are having to be navigated in the context of continuing financial pressures arising from the Nicholson challenge and the national budget freeze, as well as structural issues around the configuration of services.

Safety and patient care are critical in the health service, and it’s a real joint responsibility, from the front line to team leaders to management and up to the NHS Commissioning Board and regulators centrally. It applies across all sectors and it’s a challenge to be tackled in a systemic context – as Mid Staffs so graphically illustrates. In hospitals, patient care is about what healthcare assistants and nurses do and how they treat patients, it’s about the ward sister’s leadership skills, it’s about executive priorities, it’s about the vigilance of external regulators and the policy context set by the Department of Health.

Social care, primary care and mental health care are not immune to these challenges, and indeed many of the Francis report’s recommendations go beyond the hospital ward and out into the rest of the NHS.

But although Francis’s recommendations might be new, his message should not be – no NHS organisation should have been able to ignore the contents of the earlier inquiries and investigations into what happened at Mid Staffs and why. The importance of listening to patients, being open about problems rather than attempting to cover them up, and working with staff to ensure they feel engaged and motivated, will all sound like common sense to outside observers.

Of course, there are organisational, cultural and institutional pressures making some of this easier said than done – but there are plenty of examples of best practice that trusts willing to learn can look into. Better care isn’t always about having more money.

But executives, non-executive directors and governors each need to know their role, remember their ultimate priority is patient care, and not allow themselves to get sidetracked by trivial issues or obsessed by issues of process rather than facts on the ground.

Some are worried that the ‘stick’ approach taken by many of Francis’s recommendations – from the threat of criminal prosecutions to the emphasis on regulation – will not help struggling trusts change their cultures, but will just make them feel more under siege and more likely to make mistakes. Ultimately his recommendations are just that, and it’s up to the Department of Health to strike the right balance.

On some issues, like mandatory healthcare assistant registration for example, it’s showing no signs yet of changing its previous position (see page 30). In other areas, Francis could be implemented in full. The decisions now rest with the Government.

Adam Hewitt - Editor

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