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Will the Francis report be the Hillsborough of the NHS?

I am writing this blog instead of heading off for lunch with an academic contact.

They have had to cancel our meeting because they have to prepare for the Francis report into Mid Staffs that will come out in early 2013.

The Francis report will be the ‘Hillsborough of the NHS’ predicted one CCG lead at an NHSCC event a fortnight ago. I don’t know if his prediction is correct or not. Might we hear of a catalogue of cover-ups? Of all the boxes being ticked correctly while nurses cried to patients’ relatives about how bad things had been allowed to get? Or hear again, how staff turnover at Mid Staffs – normally an indicator of high quality – was actually low, allowing bad habits to go unchallenged?

There is a fundamental lesson we must learn from Mid Staffs – it is not an isolated case.

And saying so, does not make me an NHS-basher.

Practical Commissioning and Pulse ran a survey of 500 GPs in February this year, asking what they thought of the quality of care of their local hospital. As many as a third of respondents believed a patient had received care which was dangerously poor at their local hospital in the last year.

One in seven GPs said their local hospital was offering dangerously substandard care.

Some 10% of GPs said one of their patients had died in the last year potentially as a result of substandard hospital care, with complaints over missed diagnoses, dangerously early discharge and poor emergency care. A third of GPs raised concerns with their local hospital in the last year, in some cases with letters to clinical standards teams, but fewer than half felt confident that concerns would be acted upon.

Is this what happened with the GPs in Mid Staffs? They settled in to the NHS culture of primary care doing its thing and the hospital ‘does it thing’ down the road? The GP might visit a patient in hospital - but has to pay for parking like the other ‘visitors’.

‘Where were the GPs?’ shadow health secretary, Andy Burnham, asked at the Mid Staffs public inquiry. He had a very good point.

So it’s somewhat encouraging that a CCG lead brought up the Francis report at the recent NHSCC event. He asked how CCGs were gearing up for this potential quality bombshell. How could CCGs demonstrate things would be different in future?  

And health secretary Jeremy Hunt also appears to be gearing up for the Francis report.

In his recent speech to the King’s Fund he spoke of the need to address the ‘normalisation of cruelty’ in the NHS – though why he cited Winterbourne, a private provider, in this context is unclear. But Mr Hunt continued that ‘given the scale of the problems we’re uncovering’ in the NHS he is looking for new quality indicators to be introduced via a report that will coincide with the Francis document.

In his speech Mr Hunt speculated hospitals could have reports similar to Ofsted so all users know how their local hospital is doing.

My view is Mr Hunt needs to keep it simple and pursue the Friends and Family test which asks patients ‘‘How likely are you to recommend our ward / department to friends and family if they needed similar care or treatment? It is a test everyone can own, unlike standard mortality ratios or Patient Reported Outcome Measures. Some argue the Friends and Family test is too simplistic. But where have the other indicators, owned only by the health experts, got us so far?

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