interviews

Taking accountability

Chief executive of the Foundation Trust Network (FTN) Chris Hopson discusses leadership, Francis and the need to accept appropriate risk in hospitals.

Following the Francis report, foundation trusts around the country have been looking into their own operations and values to determine how to avoid such unacceptable practice. Strong leadership and full recognition of the failure that occurred at all levels will be vital to see the NHS through this period.

Chris Hopson, chief executive of the Foundation Trust Network (FTN), spoke to NHE about present and future challenges, as well as learning from the mistakes of the Mid Staffordshire scandal.

Hopson has had experience in the public, private and third sectors, which gives him a rounded perspective as he and his organisation seek to support foundation trusts through this period of unprecedented change.

Constant churn

He called for a period of time to allow the NHS to ‘catch up’ with the reforms and implement some real improvements, saying: “The NHS seems to be in constant churn and reform; there is a real danger this is being taken far too far.

“We have to give the system some stability for a bit. I understand why the Government did what they did but they really have to let the system grow.”

Considering whether trusts were ready for the huge changes due from April, he said: “In a sense we’re probably the most stable bit of the system. Commissioning has clearly gone through a major change; regulation has gone through some pretty signifi cant danger; it feels like we’re the most stable bit of the system.

“We’ve had the least change so we probably feel the most prepared and ready for the reform.”

No magic bullet

In light of the Francis report, there would also be a particular focus from all FTs on quality, to improve patient care and the patient experience. Hopson explained that although work was headed in the right direction on this, there was still a long way to go.

“I have some sympathy with the view that a lot of people express – if you haven’t changed things as a result of the fi rst Francis report four years ago, then really you weren’t doing what you should have been doing.

“A lot has changed, but I think it would be very brave to say that there isn’t an awful lot more change needed.

“Everybody in the system is looking at what Francis means to them, refl ecting on what they need to do to deliver the recommendations that he’s put forward.”

This will require working through a “really complex set of issues”, with quality dependent on specific circumstances within the NHS.

He added: “There clearly are pockets of poor care throughout the system.

“It’s not just poorly performing trusts; it’s not just acute trusts – it’s different wards within the same trust, it’s pockets of poor care at different times of the day.

“We resist fairly strongly the idea that there is some simple magic bullet. We’ve all been doing work on this for quite a long time and yet these pockets of poor care continue.”

Suggesting that much of the work that Francis has called for has already been achieved in the past five years makes Hopson “slightly nervous”, with a danger that this could make the NHS sound complacent – “it’s important to recognise that more needs to be done”.

Local leadership would be key in taking this forward, he said, with clearly defined minimum standards in place, properly monitored and assured.

Double failure

He explained that there were two failures to take from the Francis report; the fi rst with staff at Stafford Hospital and their quality of care, but the second in the wider system, which failed to identify and rectify this shockingly poor practice.

“In a system of 250 trusts, almost by definition there will be some failures somewhere – if you have 250 local outlets of anything, there will be some issues in some.

“You have to have a system, particularly in a safety critical industry like ours, that is able to identify where there is a problem and quickly intervene. That whole piece didn’t work effectively because there were gaps between people; people weren’t talking to each other.”

Hopson added that there had been far less media attention on the issue of assurance, partly due to the fact that responsibility for this rests between a system of national bodies, including the Department of Health and Monitor.

“One might argue this was one of the points Francis was trying to bring out. There is quite a complex system and it’s not entirely clear where the accountability for such things should lie. There were two failures here. Not just the failure of Mid Staffs but the failure of that national oversight regime.”

Addressing those issues and ensuring appropriate assurance is in place is vital, he said.

“Public confidence is an issue that is more clearly associated with the second of those – if the public can’t be sure that there’s an oversight system that is working effectively and will intervene appropriately and quickly, then it is entitled to be nervous.”

‘People will die’

Commenting on the recent government announcement to ban gagging clauses, Hopson suggested whistleblowers were a symptom of a larger failure in the system.

“It’s about letting some light in here. Let’s be very honest about this: it’s going to be very uncomfortable when that light gets shone.

“It’s only actually when you get that out in the open that you can have the kind of debate we need.”

Hopson pointed out that “the provision of healthcare is an inherently risky business” and that risk-free healthcare is simply “unachievable”. He called for the NHS to work to help the public recognise the difference between avoidable and appropriate risk and hold the NHS to account on the former, not the latter.

“We need a grown-up and mature debate. People will die in hospitals; you really need to focus on what’s avoidable and what’s unavoidable.

“I get the sense here that the fact that people die in hospitals has suddenly come as a bit of a shock to people, when the reality is that is far too simplistic.

“We’re only going to get that proper debate when we have openness, transparency and accountability.”

Forward focus

The FTN is eager to help trusts drive forward their new responsibilities with innovative leadership and a redesigned workforce.

The foundation trust model offers the NHS “complete control”, with status that “gives people some real opportunities they didn’t have before”.

This includes the chance to export leading specialist hospitals’ work overseas, as well as the move into community healthcare or to come together with neighbouring trusts to form larger alliances.

The FTN’s current focus is to consider whether the NHS has the balance of risk between commissioners and providers right.

Hopson said: “We are deeply aware of the financial challenge.

“I’m a bit of a financial determinist – the money does determine quite a lot. We recognise there are some really big challenges there.”

On the workforce, Hopson suggested that there were still savings to be found in pay and conditions, which would be essential to meet the larger efficiency challenge.

“I find it difficult to see how the system can survive five, 10 years with the current approach to pay, terms and conditions – when you think that we’re required to make 4-5% savings a year and yet 60- 70% of a trust’s annual costs come from its pay bill. There’s a real need to improve the service and offer better quality,” he said.

“We need a really big debate around workforce.”

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