Where were you at 12:30 on Wednesday, February 6, 2013? The Prime Minister was issuing a statement in parliament following Robert Francis QC’s report on the Mid-Staffordshire NHS Foundation Trust healthcare scandal. The report, which was the fifth into the scandal, followed a £13m public inquiry and revealed failures in multiple layers of the NHS resulting in up to 1,200 unnecessary deaths. Francis said of his 290 recommendations that they represented “not the end but the beginning of a journey towards a healthier culture in the NHS”.
Speaking to medical practitioners the most frightening thing about the Francis Report is that it tells them nothing that they didn’t already know. It seems as though the culture of the NHS has caused organisations to anaesthetise the ethical principles of their staff to the detriment of patient care. Should NHS dentistry be tainted with the same brush?
Candour
Although candour features in the report’s recommendations, the Government had previously announced that it would create regulations requiring the NHS Commissioning Board to include a contractual Duty of Candour on all NHS providers from April 2013. This certainly makes sense since, in my opinion, the best clinicians are not necessarily the ones who practice error-free but those who can communicate errors openly when things go wrong.
Cost control
Speaking as the report was published, Francis said that “cost control” was put “ahead of patients and their safety”. In an ideal world commissioners and managers would be telling clinicians “Your job is to deliver the best possible care and mine is to provide the resources allowing you to do just that”, however in reality this does not always happen as was the case in Bull v Devon Area Health Authority (1993) 4 MED LR 117, 22 BMLR 79, CA. In R v Cambridge HA ex parte B (a minor) (1995) 23 BMLR 1, The Right Hon Lord Justice Laws put rationing into perspective in the High Court when he said the Health Authority should “…do more than toll the bell of tight resources.”
Monitoring
The report outlines that local GPs did not raise concerns about the hospital – even though they were aware of them – until specifically asked to do. Recommendations therefore outline that practices should have systems to help them keep track of “patterns of concern” with health services.
Quality
Each of the harrowing accounts of Wards 10 and 11 suggest the delivery of a substandard quality of care. But how can quality become credibly recognised? Changing the emphasis from targets to outcomes of care and patient experience is a good start. Although the NHS Commissioning Board has announced the development of a national quality dashboard to identify safety failures in providers, this still has to be reliably interpreted.
You’ll like this…
The inquiry did conclude that the most effective means of monitoring compliance was through inspection by “well qualified, trained and experienced” inspectors. Furthermore the PM said that the CQC should establish a new inspections regime based on “quality of care”, not “bureaucratic box ticking”. The new chairman of the CQC David Prior suggested that inspections be more ‘risk based’ whilst David Behan, CQC chief executive, suggested a shift towards specialist inspections, indicating a deviation from the CQC’s current approach of regulating all health and social care providers against the same set of essential standards. This could mean CQC inspections of dental practices by dentists, which would make absolute sense. The current regime of dental practice inspections by non-dentists would be like if Channel 4’s Ramsey’s Kitchen Nightmares featured Paul Daniels instead of Gordon Ramsey. Even if our friend Paul had some training in which boxes to tick and when, he still wouldn’t be a convincing expert restaurant inspector.
Other key recommendations of the Francis Report likely to affect dentists include a new CQC registered status for those working with elderly patients, such as domiciliary dental providers, and CQC non-compliance resulting in serious harm, or even death, becoming a criminal offence. It is also likely that the CQC will take over from the Health and Safety Executive in being able to prosecute Health and Safety at Work etc Act 1974 offences.
Whilst we digest the Francis Report and consider its implications for the NHS we mustn’t forget those who tragically lost their lives in Stafford Hospital. Whether a large hospital or a small dental practice, the basic principle of all patient care is invariably the same in that, it is best provided by staff that are valued, adequately supported and given the time to care.
The views expressed in this article are those of the author and do not necessarily reflect the views of, and should not be attributed to, any organisation or institute that he works for.