Lessons of the Francis Report are not just confined to the NHS

The BGS blog has recently hosted a lot of commentary about the Francis Report and its implications for the NHS, particularly in England. It can be useful, in times of reflection, to look outside of your immediate working environment to consider what can be learned from elsewhere. The Francis Report has implications for other healthcare economies.

Here Prof Des O’Neil considers its implications for care in the Republic of Ireland. This article initially appeared on the BMJ blog.

The terrifying Francis report from Mid Staffordshire demonstrated vividly how older people became early victims of poor leadership and standards in the NHS, very belatedly recognised canaries in the coal mine.

Across the Irish Sea, a new and unhappy phenomenon is arising for older people in a mixed private and public healthcare system. A somewhat messy and porous border separates the two systems, with public and private beds in public and voluntary hospitals, as well as exclusively private hospitals which provide elective care in the main. There is much less discussion within the profession than might be desirable about the impact of the system on professional practice, with the few studies available (from general practice) showing differing treatment patterns for public and private patients . The aspiration of the current government is for a system of universal coverage, based on the Dutch model, but few are holding their breath.

Hard Truths after Francis

Professor Paul Knight is Director of Medical Education and a Consultant Geriatrician for the Elderly at the Royal Infirmary in Glasgow. He is also President of the British Geriatrics Society.

The Westminster Government’s response to the second Francis Report was published as I was preparing to go to Harrogate for the BGS biannual conference and co-incidentally where I was due to speak on what the BGS had done and would do “After Francis”. So it wasn’t until a few days later that I managed to read in detail “Hard Truths. The Journey to Putting Patients First”.

British Geriatrics Society Scientific meeting: Day 3

This week sees the 2013 BGS Autumn Scientific Meeting take place in Harrogate. This international multi-disciplinary conference is for professionals concerned with the the health and care of older people. We will be presenting a packed scientific programme, with updates on a variety of clinical topics covering several special interests.

The third day of our conference opens with two parallel sessions (9.00-10.30):

• Session Q: Bereavement: Beginning with Prof David Jolley (University of Manchester) on psychiatric disorders after bereavement. Next is Mr Alan Casseden (Cruse Bereavement Care) on who will be encouraging attendees to reflect on their own death. Finally Dr Peter Dean (Coroners Office) describes changes in the coroner’s jurisdiction.
• Session R: Care Homes: Dr Clive Bowman (City University, London) begins with a presentation entitled: “Care Home Medicine: Outside the box but not at large.” Dr Adam Gordon (Nottingham) will discusses “Comprehensive Geriatric Assessment in care homes”, and Ms Julie Whitney (Kings College Hospital) will speak about on falls prevention in Care Homes.

British Geriatrics Society Scientific meeting: Day 2

This week sees the 2013 BGS Autumn Scientific Meeting take place in Harrogate. This international multi-disciplinary conference is for professionals concerned with the the health and care of older people. We will be presenting a packed scientific programme, with updates on a variety of clinical topics covering several special interests.

The second day of our conference opens at 9.00 with the President’s Welcome Address, followed by an update on the BGS response to the Francis Report.

Session G (9.20-10.30) is dedicated to Syncope beginning with Prof Roseanne Kenny (Trinity College Dublin) on the assessment of the older patient with syncope, followed by Dr Michael Norton (South of Tyne and Wear) who will be discussing when a cardiologist should see an older patient with syncope?

2013 – The Year of Francis

When writing the history of the NHS, historians will dub 2013, “the year of Francis”. His name is invoked in the majority of lobbying documents and reports produced recently.

In the June issue of the BGS Newsletter, Professor David Oliver analyses the report: “Patients First and Foremost“, the Government’s response to the Francis recommendations.

Professor Oliver says: “As Francis himself has pointed out, many of the recommendations he made are things that we as doctors, nurses and allied professionals, whether delivering hands on care or in leadership roles, should have been getting on and doing in any case, without waiting for the Final report, or the government response. And those actions would be equally important in any of the four nations, the Irish Republic and beyond. Francis should not be seen as an “England only” issue.”

BGS Belfast Spring Meeting – Conference Report

“All patients were by legal definition vulnerable, but older patients who might be confused, frightened and without family were even more so and any doctor who ignored that would be condoning institutional abuse.”

The hard hitting message was delivered to the BGS’s Spring Meeting by guest lecturer Robert Francis QC, chairman of the Mid Staffordshire inquiry, who told us: “We know that most of the issues were nursing ones but medical leadership is the key to solving them. All doctors should be in a position to take the lead.”

Doctors in Mid Staffordshire had failed to intervene for a variety of reasons including a sense of disengagement, a reluctance to rock the boat or make a fuss, fears about discretionary payments or pensions. The result was a catalogue of horror stories, some of which he described to his audience to whom he issued a plea, “Remember these stories and don’t ever fall into those categories. The future is in your hands.”

Francis Report – A Nursing Perspective

Jane Buswell is Chair of the BGS Specialist Nurse and Senior Practitioners Group

On reading the Francis report one might be misled into thinking that the report points to nurses as having sole responsibility for delivering compassionate care and that the only professionals delivering care within the NHS are nurses and doctors. It is unfortunate that the significant role of our Allied Health Professional colleagues within the multi-disciplinary team, and their potential for leadership, has not been recognised in this wide ranging and seminal report.

It would be wrong to look at the individual professional recommendations in isolation. Only 33 of the 209 recommendations are specific to nursing. However, many of these are addressing the same issues of leadership, training, regulation, professional accountability and the roles of our professional bodies, all of which apply equally to doctors, and all other professionals within the NHS.

Interesting times indeed – the Francis Report and Care of Older People

Prof Paul Knight is President of the BGS and is Director of Medical Education and Consultant Physician at the Royal Infirmary, Glasgow.

The oft quoted expression, “may you live in interesting times”, not as approbation, but as a threat, certainly seemed to apply recently.

Apparently, it probably isn’t a Chinese proverb but appeared in a science fiction novel in the 50’s. As I was preparing my contribution to this edition of the newsletter the Francis report was released. There will be much about the report elsewhere in this and subsequent newsletters, as we consider what it means to the way we work.

Inevitably, Francis means most to colleagues working in the NHS in England, but I would urge all to review the Executive summary, not least because Robert Francis will be an invited speaker at the Belfast Spring Meeting and it will give you some context. The recommendations for regulators such as the GMC and NMC will apply UK wide and not just in England.

BGS on the Francis Report

The Francis report challenges the NHS at all levels. Many of the failings in care described in the report affected old and vulnerable patients. Policy, regulatory, organisational, funding and professional lessons must be learnt.

There must be an immediate focus on what we know will improve quality. Central to this is the need for health professionals to demonstrate clinical leadership. They should be advocating for patients and their carers, challenging poor practice and embodying good practice. No doctor or nurse should assume that failings in basic care, safety or dignity are someone else’s problem and all should speak out when they see neglect or poor care. This extends to clinicians in senior leadership roles in hospitals who should have a clear focus on the care delivered on wards and experienced by patients and their families.