A Year after Francis

The report by Robert Francis into shortcomings at the mid-Staffordshire hospital caused waves through the NHS establishment and very real shock and alarm for the general public who need to have real and lasting confidence in our public health system.

There have been calls for increased staffing levels, more practical training and for greater protection for whistleblowing, where courageous and persistent campaigners have been recognised and, indeed, honoured.

There has been understandable horror at what Francis discovered and there have followed very well intentioned demands for immediate action.

Extra staff are welcome. Whistleblowing is, in essence, protection for employees where public spirited disclosure may be seen legalistically as a breach of their contractual obligations.

However, the solution, we believe, is achievable and affordable, by focusing not only on evidence of bad practice but also by removing the very real evidence that those who have in good faith questioned or challenged their experiences were dismissed as irrelevant, or worse, dangerous troublemakers.

All NHS providers are required to provide and support an effective patient complaints service. The problem, here, has not been the absence of such schemes, but, rather, the failure to properly resolve and support such complaint services.

Most complainants are not troublemakers. Many simply wish their experiences to be understood so that those experiences are not visited on others. Dismissal and vilification turns such public spirited people into those who are angry and absolutely determined to have their say heard loudly.

Trusts should take two simple actions:-

  • Properly resource the complaints service with sufficient staff and funds to ensure that issues can be acknowledged, investigated and addressed promptly (In NHS finance terms, the costs will be insignificant). The complaints service should genuinely be seen to be owned by Trust Boards.
  • All staff in Trusts should understand that they will be expected to respond in set time scales for requests for information from the complaints service.

These requests should be disciplinary issues for everyone from Senior Managers and Clinicians to all grades of support staff.

Prompt information will enable complaint investigators to report to managers and complainants so that concerns are both understood, explained and addressed.

This is much more effective than waiting for angry whistle blowers to raise issues externally and away from provider Trusts. It will encourage internal solutions, improve patient experience and satisfy a very large proportion of complainants. It is also very likely to significantly reduce clinical negligence claims which often arise out of frustration at not being heard.

The infrastructure is in place. Additional resource required is really limited. Encouraging staff to do the right thing is more effective than vacuous threats of criminalisation (not convincing to lawyers skilled in prosecution).

The certainty of proportionate disciplinary action for non-compliance is likely to be more persuasive than improbable threats of personal shame.

This suggestion can be effected immediately and would surely meet with very little objection.

We urge NHS England to consider this proposal as a real alternative to address one of the real major concerns raised by Robert Francis.

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