The report of the Mid Staffordshire NHS Foundation Trust Enquiry (2013) chaired by Robert Francis QC has been presented to Parliament. This follows the publication of an initial report in 2010 (The Mid Staffordshire NHS Foundation Trust Enquiry, 2010) concerning issues associated with mortality and standards of care at the Trust. However, it would appear that no lessons have been learned since the first Inquiry published its findings. There has been a plethora of reports emanating from various inquiries (Shipman, Winterbourne, Bristol Royal Infirmary, Victoria Climbié), which have all indicated the need for better training of staff, improved management and a focus on outcomes as opposed to targets. However, the public remains unconvinced that this has been achieved.
Once again those responsible for the decisions that led to the abhorrent actions are redeployed or promoted, and when there is no penalty for failure there will be no modification of behaviour. As such it is certain to occur again. This is stark when considering that the current NHS Chief Executive, Sir David Nicholson, still has his job. Sir David told a Health Select Committee (he was in charge of the regional health authority for part of the period when patients at Stafford Hospital were being mistreated and abused) that at the time of the scandal, patients were not at the centre of this Trust’s attention. During the time he was running the health authority he only visited Stafford Hospital once, despite the gross concerns being raised.
The NHS is currently facing its biggest challenge and it is Sir David who is leading the NHS through these changes. Sir David told the Select Committee that he has a duty and a responsibility to manage the organisation over these great changes, yet it remains questionable whether he has the ability to do this.
Paramedics may feel they have little affinity to the report. However, there are many learning points that are applicable to all sectors in health and social care.
Of the 290 recommendations, not one can prevent a repeat of what happened at Mid Staffordshire. Instead all of the recommendations must be considered together.
Although employers have a duty to help staff carry out their responsibilities in order to ensure patient safety by providing them with resources and support (against a back drop of austerity measures), accountability for actions or omissions lies with the registered paramedic in acting in the best interests of the patient. Safe and effective paramedic care is a patient’s right and as such must never be seen as an optional extra.
The Francis Report has raised a number of uncomfortable questions, particularly concerning the care of those who are older and more vulnerable. There is a need to reinvigorate staff by refocusing on what is important, spelling out the role of the NHS, and creating a sense of common purpose.
Take heed practitioners, managers and senior executives of the content in the Francis report, lest a similar report is published concerning the services provided by paramedics and ambulance services. Use the recommendations in the report as a blueprint for the production of high-quality paramedic services that puts the patient truly at the heart of all that is done.