When some ill-advised bloggers in the US attacked the British National Health Service in the summer of 2009, little could they have realised the fire-storm they would unleash as angry Brits fought back with the #WeLovetheNHS hash tag campaign.
Some commentators have suggested that the NHS is the nearest things the British have to national religion (more so even than football, and definitely more so than the Church of England!). Its prominent place in the Olympic opening ceremony last year only cemented that reputation.
But the horror stories that have emerged from the evidence gathered in the multitude of enquiries into the failure of care at Mid Staffordshire NHS Trust have shaken that belief. Horror stories of patients left in soiled bedclothes because nurses were too busy to take them to the toilet, people being triaged by A&E receptionists, and myriad other abuses and neglects. Hundreds of patients are thought to have died unnecessarily as a result of poor care.
What is more, the stories of nurses, doctors and others who tried to raise concerns either being intimidated into silence or ignored by regulatory bodies and management suggested that this was more than just a local failure. There was something rotten in the state of the NHS.
Today’s publication of the second Francis Report has sought to address this wider, systemic failure to police the care standards at Mid Staffs. And Robert Francis QC has spared no one’s blushes in his report. The trust management are castigated for a blind focus on targets and cost savings at the expense of frontline staffing and quality of patient care.
The professional bodies (most notably the Royal College of Nursing) are attacked for a failure to support or take seriously whistle-blowers. Other regulatory bodies, professional bodies, educational institutions, the NHS Executive and the Department of Health all come in for criticism.
The other central theme is that there needs to be an overall culture change in the NHS that puts patients and their needs at the centre of the system. This seems so fundamental that the inquiry’s need to state it explicitly and in detail suggests how far NHS structures and institutions have drifted away from their original purpose.
Francis makes 290 recommendations – it is not a short or easy read, even for a public inquiry! Central to them is that transparency becomes a legal duty for NHS trusts and professional bodies – a ‘duty of candour’ should be legally enforced on all NHS staff, enforcing honesty about mistakes. Furthermore, gagging orders to stop disclosure of ‘unpleasant’ stories in the media should be made illegal, and professional bodies must be more proactive in supporting whistle blowers reporting on failures of care.
Significantly, while good leadership is vital to this, Francis makes it clear that the culture change is the responsibility of every NHS employee, from ‘porters and cleaners to the secretary of state’. It is a bottom up change, not further top down restructuring that the inquiry advocates.
There are many other fundamental changes in the report’s recommendations (merging regulators, mandatory registration for all healthcare assistants, criminalisation of serious neglect leading to the death of a patient etc.).
David Cameron today expressed sorrow for the suffering caused to so many families, announced a new chief inspector for hospitals and promised a full government response to the recommendations in March. All the other bodies that are named and shamed in the report are also promising to take action – but we wait to see how much that is just good PR and how much actually changes in the long term.
I think it not insignificant though that it is openness and compassion that stand out as the key issues. Because not all of the NHS is providing bad care for patients, in fact most hospitals and units are providing good care. And where good care is provided, it is out of a culture of compassion and openness. The failures that Francis highlights are that the system does not deal well with cases where care begins to break down and standards fall. It is also clear that failures of care are not due to one or two causes – they are caused by myriad problems – bad leadership, short staffing, target-driven culture, organisational self-serving, etc.
I also think that it is intensely hopeful that the report calls for a bottom up revolution in the NHS. It reminds us that each one of us can change the way care is given where we work. We can be the change we want to see in the NHS.
The Bible speaks throughout of a God who passionately cares for his creation and acts constantly out of compassion towards his people. Speaking truth in all situations, standing up for the poor and vulnerable, showing compassion and kindness to all as bearers of the image of God himself, are central virtues in Christian living. It is out of these values and virtues that we can build a culture of compassion, care, openness and honesty. I believe that gives Christian medics and nurses a strong starting point to be agents of change and so we should be ready to embrace this call to see transformation in the NHS.
Many are calling this a ‘watershed moment’ for the NHS. In Christian theology we would use the term ‘kairos’, a historical moment into which ‘eternity erupts, transforming the world into a new state of being’. Whatever words we use, we should see the report as an opportunity to be embraced for something new to happen in our National Health Service.
So let us not just hope that the Francis Report does not sit on a shelf and get forgotten along with all the other reports into institutional care failures in the NHS. It is down to each one of us not to let it be forgotten!