The Francis Report asks questions which need to be answered with new solutions, says Lisa.
The publication of Sir Robert Francis’s report into the failures of Mid Staffordshire NHS Trust is one of those climatic moments that confronts us with all we have not done in the past and leaves us reeling with all the opportunities we have to do things differently in future.
There are some key words that recur again and again in the report: accountability, culture, compassion and listening. In all the thousands of words already on paper and the millions yet to be written, one thing is clear: that the NHS has to change so that the person is at the centre.
To bring about this change, the management gurus stress the importance of leadership, and it is true that frontline staff will need to the support of management at every level, if they are to be free to practise compassionate and person-centred care. But, as we have seen in the campaign that brought the mid Staffs scandal to book, carers, patients and support groups have a critical leadership role to play also. Julie Bailey, who led the “Cure the NHS” campaign, said that she succeeded because she never lost sight of what was important and she had a fantastic group of people behind her. The NHS needs that energy and commitment. People who use health and social care services, their families, local groups and third sector organisations must be equal partners in the effort to transform systems to put the person first.
It was by and large the vulnerable who suffered most in Mid Staffs. This tells us that human rights safeguards are essential and that it is vital not to underestimate the importance of hearing the voices of those who are most easily ignored. Their experiences alone are a powerful driver for change. Robert Francis commented that “the experience of listening to so many accounts of bad care, denial of dignity and suffering made an impact of an entirely different order to that made by reviewing written accounts”. It is time for training through direct contact with “experts by experience” to become mandatory for every student and practitioner in the NHS. The NHS cannot not afford the time for this to happen. There are some brilliant examples in Scotland of how this can work well. For example the online DVD “Listen to me” shows how one man’s experience in hospital can be a valuable learning tool that can improve understanding, communication and behaviours in the interest of all patients. Edward Stanton is not a victim, but a citizen who is prepared to stand up for his rights and to explain how things could be done differently. Another example is the Good Life Group, a group of people with learning disabilities who regularly train NHS staff in how to work in a person-centred way.
People who use health and social care services are part of the solution and listening to them will change hearts and minds and rebuild fractured relationships. A word that occurs less in the Francis report, if at all, is power. Yet it is clear that managers, staff and patients all need to be empowered – to advocate for human rights and basic dignity and to speak up without fear. We need leadership academies for health service managers, yes, but we also need to invest in building the capacity of people who use services and resource the groups that represent them, so that they can work alongside NHS staff, and rebuild the connections between local services and their communities. Again there are many examples of how this can work well, and of the return to be had on small investments. GP practices that struggle to meet demand have found real benefits in having closer links with local group that can offer their patients support and opportunities to live full and healthier lives.
In Scotland some of the strategic levers are already in place to drive the changes needed. The Quality Strategy for the NHS in Scotland has three key ambitions for our care: that it should be safe, person-centred and effective. These three all go together. The Patient Safety Programme has proved its effectiveness and now the National Person Centred Health and Care Programme aims to demonstrate how person-centred practice can become a reality at every level. There is a named person accountable for that work in every NHS Board. A key component of the programme will be explaining how the voices of people who use health and social care services can be influential and how third sector organisations can work alongside health staff and managers to improve services. At the same time the Scottish Human Rights Commission is leading on the development of a National Action Plan for Human Rights which will provide a strong basis right across the public sector for promoting and safeguarding human rights. It will help to ensure that both values and accountabilities are clear to everyone.
The changes of culture and systems required are so great that we will need all the human resources available to bring about real and large-scale improvement. So perhaps it is important to remember that massive cultural change has happened and can happen again. After all we did close the institutions for people with mental health problems and learning disabilities. It is salutary to remember how daunting a challenge that once seemed. When Enoch Powell in 1961 spoke about the need to demolish the “isolated, majestic, imperious” asylums, he also referred to “the sheer inertia of mind and matter” which would have to be overcome and he warned: “Do not for a moment underestimate their powers of resistance to our assault”. We now face a challenge of equivalent magnitude. It is no less than the need to turn systems on their head and to put the person, not the chief executive or the target, on top. The knowledge of how to do this is being built – in the movements for self management, in self-directed support and in citizen leadership. It is time to trust that people do know best. Instead of getting in their way we must bend our joint energies to removing the barriers that isolate them from their communities and that stop them and those who care and support them taking charge of their own living and dying.
Dr Lisa Curtice has just taken up post as Programme Director for People Powered Health and Wellbeing, a third sector programme based at the Health and Social Care Alliance (the ALLIANCE) which will take forward the co-production strand of the National Person-centred Health and Social Care Programme.