06.02.14
Francis’ ‘concerns’ at regulators’ behaviour, one year on from his report
Financial constraints are making it difficult to achieve the patient-centred culture set out in the Francis inquiry, a new report from the Nuffield Trust cautions.
Published one year on from the original Francis recommendations, the new research found that the tougher regulatory structure was also proving challenging for NHS hospitals.
But of those responding to the Nuffield Trust’s survey of chairs and chief executives, 82% said they were taking new action in response to the Francis report and 93% said they had already had relevant work underway in line with the recommendations when the report was published.
Increased demands for scrutiny and assurance may be making it harder for hospitals to focus on promoting patient safety and quality of care, thanks to the “burdensome regulatory approach”. Additionally, while hospitals were encouraged to assess the heath of their organisations, there was no such mechanism in place to assess how the whole system was functioning.
Commenting on the Nuffield Trust’s research, Robert Francis QC said: “It is reassuring to see that in large part the respondents to this research appear to have embraced the need to learn from the two inquiries into Stafford and the alarming events which they described. In particular there appears to be general acceptance that quality needs to be given a much greater priority.
“It is concerning, however, that some respondents reported that national bodies have persisted in some of the behaviours towards hospitals that evidently contributed to the problems identified by the two inquiries.
“If true, it would suggest that the lack of co-ordination and elements of the system-based culture so evident in the regulation and oversight of Mid Staffordshire have persisted in spite of the assertions to the contrary by the regulators.
“It is vital that national bodies exemplify in their own practice the change of cultural values which all seem to agree is needed in the NHS.”
Ruth Thorlby, report lead author and senior fellow in health policy at the Nuffield Trust, said that many of the strategies being used to improve quality were “resource intensive”, causing further financial pressure.
She said: “Some of the interviews suggested that hospitals are involved in exacting interactions with commissioners and regulators, which have also responded to the Francis inquiry findings by seeking increased assurance that quality and efficiency are being delivered by hospital trusts.
“It is important that these interactions between hospitals and the wider NHS system are conducted in a fair and responsible manner, and that there is some independent and evidence-based way of establishing whether the dysfunctional relationships amongst the regulatory and commissioning bodies and between them and hospitals described in the Francis Inquiry have been rectified and improved.”
Dean Royles, chief executive of the NHS Employers organisation, said: “It's great that people are seeing very visible changes following the Francis report. But we need to be careful to avoid the fallacy that the progress has happened by accident. It has involved a huge amount of local leadership, dedication, creativity and energy in an incredibly complex context.”
And Dr Peter Carter, chief executive and general secretary of the RCN said: “It's certainly excellent news that we've seen many trusts begin to strengthen their numbers of frontline nursing staff and that our warnings since 2010 have started to be addressed. It’s now vital that all Trusts see employing and maintaining adequate staffing levels as a top priority.”
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