The NHS should exploit the idealism of its doctors and nurses – not crush those put patients first, warns Sir Robert Francis, ahead of his landmark report on whistleblowing
Sir Robert Francis QC is poised to publish the results of a landmark inquiry into perhaps the greatest NHS scandal – the failure of the health service to take heed when its own doctors and nurses warn that patient safety is at risk.
His review has taken two months longer than expected, after he was deluged with more than 18,000 submissions.
Senior doctors and nurses told how their careers were left on the scrapheap, after they tried to alert NHS managers of unsafe practices and cost-cutting risking lives.
Sir Robert was appointed by the Health Secretary to lead the review last June, after chairing a public inquiry which scrutinised years of appalling care at Mid Staffs Hospital, where staff who tried to speak out told how they were bullied, and even afraid to leave hospital grounds unescorted.
Just before he was appointed to lead the review, he told The Telegraph of his fears about the culture of the NHS – and why his own son gives him a vested interest in the future of the NHS.
As chairman of the Mid-Staffs inquiry, Robert Francis QC heard devastating testimonies about basic failings in patient care, for more than 3 years, from almost 300 witnesses.
But for the barrister, 64, equally compelling messages came from one source far closer to home.
While Mr Francis (now Sir Robert) spent three years hearing about the worst behaviour distorting the values of the health service, until his inquiry reported in 2013, his son was making his way in life as a trainee doctor.
“I have a personal investment in the future of the NHS, in that regard,” said Sir Robert, speaking from his legal chambers, off Fleet Street, last May.
“I have learned from my son, and from other trainees, that we can learn a lot from the fresh eyes and idealism that doctors and nurses have when they start out. It is so important to exploit that, and not to crush it.”
Sir Robert believes that many of the worst failings in the NHS occur when clinical staff become powerless — are left “shrugging their shoulders” rather than challenging poor care.
He was encouraged, he says, by changes introduced by the Government to improve openness and transparency, including an overhaul of NHS regulation, ratings for hospitals and improvements to training of staff.
But he feels more should be done.
In particular, the leading QC wanted changes in the law to put the onus on staff to speak out if patient care is at risk – specifically a legal duty of candour to be placed on health professionals.
“We do need to protect individuals by making sure they feel safe to report things to their employers,” he says. “I felt a statutory duty would have assisted that — too often those who raise concerns about things that go wrong become unpopular with colleagues and they need some form of protection.”
He also raises concerns about “complacency” in the health service, with too great a tolerance of errors and failings in care which can prove catastrophic.
“The vast majority of those receiving care in an NHS hospital get perfectly acceptable care,” Sir Robert says. “The trouble is it’s no use being satisfied or complacent — if we ran our airline industry on the same basis planes would be falling out of the sky all the time.
“We’ve just got to change the attitude that because it’s provided by the state, it’s all right for a number of people to be treated badly — well, it’s not. Airlines would go out of business very quickly if they worked that way.”
Sir Robert suggests that deference to medical professionals — “allowing them a God-like status” — and pride in the NHS have stifled political debate about its failings.
But he believes the culture of the NHS is changing, crediting Jeremy Hunt, the Health Secretary, for a “refreshing change” of approach in standing up for patients, suggesting that his predecessors — from both parties — tended instead to act “as a spokesman for the NHS”.
He also suggests too many hospitals use financial problems as an excuse for poor care. “If you can’t afford to look after your old people or your children safely that’s just unacceptable,” he says, “and I don’t believe when it comes down to it that lack of money is a justification.”
A month after the interview, Sir Robert was appointed to lead the first ever inquiry into the treatment of those who try to blow the whistle on poor care.
As he made a public call for evidence, he told The Telegraph that he feared too many had been hounded out of the NHS by “a culture of denial and fear”.
Sir Robert said increasing numbers of whistle–blowers had contacted him since his public inquiry reported in 2013.
“Since the inquiry I’ve had a lot of people talk to me about the culture of fear that prevents people speaking out,” he said.
Sir Robert said the Mid Staffs inquiry had exposed the “consequences for patients when there is a ‘closed ranks’ culture” – and warned that every time the NHS treated a whistleblower badly, yet more were deterred from “doing the right thing”.
The inquiry has heard from senior doctors and nurses who say they were hounded out of their jobs, with some losing their homes, careers, and health, after going public about their concerns.
In response, the Government is expected to outline changes in the training of doctors and nurses, to emphasise the importance of whistleblowing, in a bid to change the culture of the NHS.
A new watchdog, the Commission on Education and Training for Patient Safety, will aim to change the culture of the NHS, so that all staff – whatever their rank – are encouraged to speak up if they see risks to patients, regardless of where the fault lies.
Mr Hunt has already promised an annual review of 2,000 deaths a year, to determine just how many could have been avoided, with the right care.
The annual review will be used to monitor NHS performance, and hospitals will be assigned estimates of how many deaths might have been avoided, given their safety record.
Mr Hunt told the Telegraph the reforms are “the most profound change to happen while I am Health Secretary” and would mean the NHS followed the lessons of the airline and nuclear industries, which have radically improved their safety record.”