We hope and expect that implementation of our Recommendations will ensure that the opportunity for radical thinking and root and branch action is seized. Nothing less will satisfy us and all those who so passionately spoke to us during our hearings
These words are not taken from the long-awaited Francis report, but rather from the Macpherson inquiry report (1999) into the death of the black teenager Stephen Lawrence on a south London street in 1993.
There are a number of interesting parallels between the Francis and Macpherson reports. Both followed lengthy inquiries into specific incidents involving local “branches” of much wider public services – the Metropolitan Police and Mid Staffordshire NHS Foundation Trust. Each inquiry team was exhaustive in the way it examined the evidence presented to it. Both reports provide a damning analysis of unjustifiable operational, management and systems failings.
Arguably, the real significance of both reports is not simply what they told us about the individual public services concerned, but rather what they revealed about society and our expectations of key public services. The true relevance of the Francis report is not simply limited to the relatively small number of NHS hospitals; rather, its findings will impact across the whole health and social care system. Just as the Macpherson inquiry report led to systemic changes within the Metropolitan Police and all other police forces, so Francis must trigger a recalibration of all health and social care services, regardless of location, size or the type of organisation providing the service.
All organisations which deliver health and social care services would be wise to spend the next few days and weeks determining what the report’s 290 recommendations mean for their services and the people they care for. Just as it is not possible to read Francis’ weighty report in a single sitting, so it will take a significant period of time for all of us to get our heads around what we need to do as a result.
The thing which ultimately determines whether such a report sinks or floats; whether its recommendations are fully implemented or gather dust on the shelves alongside so many other reports down the years is political will. The primary reason why people remember the Macpherson report is because the government of the day took its lessons and not only ensured that they triggered change in the Metropolitan Police and the wider police service, but also legislated to ensure that, through the Race Relations Act 2000 (Amendment) and the Race Equality Duty, it led to more wholesale changes to the way all public authorities addressed the issues it raised.
The proposals set out in the Francis report are wide-ranging and ambitious. They include a shift to more patient centred services, an emphasis on zero harm, renewed stress on transparency, fundamental challenges to professional practice and priorities and a wholesale rebalancing of regulation across the health and social care system. The sheer number of recommendations means that it cannot possibly succeed without robust political backing. Day one, at least, suggests that such political will might just exist. The Prime Minister’s decision to deliver the government’s formal response underlined the importance of this issue and hopefully underscores the degree of political commitment to implementing its recommendations. The Prime Minister’s response made clear that the government is pushing ahead to deal with a number of issues raised by the report. He has asked Don Berwick to examine how the NHS can implement a “zero harm” approach and Sir Bruce Keogh is reviewing the five NHS Trusts with the highest mortality rates; small steps, but a start nonetheless. The real work and the true test will come over the coming months. Change will require major decisions about the introduction of a statutory Duty of Candour, a fundamental rebalancing of priorities, major shifts in nursing and other care services and a reorganisation of the regulatory landscape with a likely shift in powers between Monitor and the Care Quality Commission and other regulatory bodies.
The next few months will determine whether there is the political will required to push through the raft of changes to attitudes, perceptions, responses, professional norms and working practices set out by the Francis report. It will also help determine whether, like Macpherson before it, the Francis report is destined to be cited for years to come as a real agent of change, or whether it has more in common with other authoritative reports which have been delayed or simply disappeared from view because of a lack of political will or the absence of a cross-party consensus.
Dr Phil McCarvill is Head of Policy at Marie Curie Cancer Care
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