On Wednesday I attended the King’s Fund Francis inquiry event – a lively and constructive forum exploring outcomes and implications of the Francis Inquiry report. I joined the afternoon panel, which looked at board governance and effective leadership in the post-Francis era of provider care.
The discussion was excellent and I sensed a positive energy of change and optimism. This enthusiasm, which I’m noticing in many places at the moment, is perhaps one of the most positive things to come out from the report so far. Although what took place at Mid Staffordshire was a deeply shameful moment in the NHS’ history, the incident has acted as a spur to make the changes we know we need to make. It’s presented us with an opportunity – the biggest we’ve ever had – to re-examine and manifest the core values we place on our healthcare system.
For some however, the report acts as the next set of instructions on how the system should manage quality improvement of services. We’ve moved from a ‘waiting for Francis’ anticipation to the start of what is perceived as a long and intimidating journey into the unknown. This perception is unsurprising. The sheer number of Francis’s recommendations, 290 in total, and the fact that they cover nearly every aspect of the system – is daunting. Our leaders will have to juggle all of this on ever-tightening budgets, in ever-changing operating environments, for vastly-evolving patient needs. Where do we start?
A point I made at the King’s Fund event is that in my experience good leaders are those who are able to create streamlined objectives and take complexity out of many aspects of change. The Francis report states that the problem with provider care is that it is often characterised by “negative aspects of culture”, including “a lack of criticism”; “a lack of consideration for patients”; and “defensiveness”. And, yet, for many years, organisations from across the service have avoided these characteristics by driving everything they do by organisational values, engaging with staff at all levels and putting patient needs before doing the business of care.
The point is that these ideas aren’t particularly revolutionary or something we’ve never heard of before. Indeed, the first Francis report three years ago focused heavily on elements of culture, patient safety, and staff and patient engagement. And going back even further, the very constitution that the NHS is based has always afforded pride of place to all of these elements.
Many organisations have shown that powerful and lasting changes can happen, even with all financial and structural challenges we have to grapple with. There are numerous examples out there of excellent staff engagement initiatives, ward to board leadership and patient interaction. We can look to these organisations and emulate their success. We can revisit organisational and constitutional values and live them in everything we do and all the decisions we make.
And we need to always keep in mind that many of the changes we need to make are those that we already know, believe in and value.
The essence of Francis and the Health and Social Care Act is that individuals and leaders take more responsibility, and the way each of us responds is in itself part of the culture shift we need. So I urge people not to wait, but to act now. We know that there is a lot to be done and leaders at all levels will be supported by the Academy to develop the behaviours and competencies the new system needs.