My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Opening up different ways of responding to the Francis Report

Filed Under (Alan Milburn, Francis Report, Regulation) by Paul on 16-01-2013

Both the Government and the NHS are gearing up to respond to the Francis Report on Mid-Staffs that will be published in the next few weeks. I am aware that some Trust Boards have already set aside dates to think through the report and their response to it. Given the importance of the way in which culture works in NHS organisations, it will be vital that they develop ways to reassure the public that they have a culture of care and safety. Culture – “the way we do things around here” – sets the parameters for the way in which staff and patients operate. Board leaders thinking through how they help set the tone for their staff is a crucial part of the response.

But we also know that the Francis Report will make a number of recommendations about how the national system of NHS services is organised. Some of us have been trying, not very successfully, to make the case that increasing the amount of national regulation of NHS trusts may give people on the front line the impression that quality is an issue for national organisations and not front line staff and their culture.

The expectation is still that the report will demand more national regulation and that the Government, having set up the report, will have no alternative but to carry out its recommendations to the letter.

On Tuesday January 8th Alan Milburn demonstrated, in an article in the Times, how a powerful Secretary of State can reframe the terms of a debate by writing an article providing an alternative response to the failures at Mid-Staffs.

He posed a direct alternative to regulation which would of itself have a much bigger impact on public empowerment than would employing hundreds more inspectors to write thousands more pages of reports. The essence of his argument was in the headline “”Patients can be the smoke alarms of the NHS”.

Just to unpick the analogy in that headline, 50 years ago the main defence against injury or death by fire in your home was the rapidity of the fire service’s response. Nowadays the first line of defence is the smoke alarm. One of the main activities that fire-fighters now carry out is to encourage the fitting of fire alarms and to ensure they are kept fully functioning in as many buildings as possible. It is of course true that fire-fighters still save lives, but fire alarms with their much earlier warning save many more.

How does this relate to the provision of NHS services? Of course we need a public form of inspection. But given the public are there in every consultation and involved in all aspects of their health service, they need to be allowed and empowered to say that something is going or has gone wrong.

What Alan Milburn was arguing for was to complete the revolution that started a few years ago with the publication of more and more information in the public domain. His point is,

“There is a direct relationship between giving power to consumers and improving standards. A decade ago I (Alan Milburn) had to fight to publish risk adjusted data on heart surgeons. Today it is published by the society representing those surgeons. Since 2005 1000 lives have been saved each year. Primarily this was because clinicians with relatively poor performance rates took steps to improve…. In Sweden public reporting of mortality data for heart attacks prompted the lowest performing hospitals to cut their mortality rates in half within 2 years” (Times 08/01/2012 page 8)

Only just over a decade ago not much was ever published about the NHS and its services. In September 2001, for the first time, the Government published a set of star ratings about NHS provider trusts and, as he pointed out, more and more data has since been placed in public hands.

But it is still the case that my doctor friends know much much more about which providers are better and worse than the public do. We need all that information out there.

We then need all providers – public and independent – to be prepared to listen carefully to what the public are saying about the quality of care in all institutions. It is this that is the main line of defence against any drop in quality.

His point with regard to policy change following the Francis Report was that,  “With the best will in the world, regulators eyes cannot be everywhere. But patients and carers can”

Much of my blogging these days explores the different ways in which patients must be more involved in adding value to their own health care. Playing the lead role in keeping quality standards high would be another part of this new compact.


3 Responses to “Opening up different ways of responding to the Francis Report”

  1. […] Paul Corrigan was formerly senior health policy adviser to Tony Blair when he was prime minister. This post first appeared on Health Matters […]

  2. For the NHS to provide more performance data, it needs both local hospital trusts to collect the data and national targets, standards, codes of practice – and systems – to define the data and process and present it to patients in a useful way.

    Another example is Referral To Treatment (RTT) data which has been collected since August 2007 and which has driven substantial improvements in waiting time performance throughout the NHS. This data is collected locally and forwarded to the Department of Health which publishes the data, in a fairly raw form for expert use, and in a much more limited form through NHS Choices for patient use.

    Unfortunately, the use of RTT data on NHS Choices is extremely misleading and fundamentally flawed – they present data only for completed treatments and not for the real waiting lists (the Incomplete Pathways) – which ensures that patients are not provided with the comprehensive, accurate and up to date data on waiting time performance which patients need to make an informed choice.

    RTT data provides a good example of how NHS performance can be improved by data collection (local) and presentation (national), and by national targets. It has taken several years and there is some way to go before it will be working effectively for patients as well as for the NHS, and much more needs to be done in other areas to ensure that the NHS opens up its performance data to the public.

  3. George,excellent summing up especially when the NHS Trusts funding works on an annual basis so dealing with backlogs can become a low priority or cause large deficits by coming out the current years budget.Not good for patients

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