Comment / Message for all

By Tony Whitfield

The Francis report identifying system failures at Mid Staffs also poses challenges for all staff in support services and on the front line

As we entered February, it felt a little bit as though the NHS was braced for the Francis report. The hard-hitting report duly delivered a stark reminder of the unacceptable levels of care delivered at Mid Staffordshire NHS foundation Trust for a period of years from 2005 and the devastating consequences for patients and their families.

The fact that the regulatory system within the NHS failed to pick up on warning signs – the focus of this specific inquiry and report – also made for uncomfortable reading. However the report steered away from the criticism of individuals, identifying instead systemic failings at every level.

But this ‘system’ focus should not stop us as individuals and as members of finance teams from understanding how we can make our own personal contribution to ensuring similar failings do not happen again. There are many high-performing organisations across the NHS, but all have room for improvement and there are lessons in the Francis report for all parts of the NHS, whether through opportunities to challenge or to change existing practices.

So my challenge to you is to find the time to read the Francis report or at least its 100+ page summary (including its 290 recommendations). For me, it underlines the complexity of healthcare and the dangers of relying on assurances that, with hindsight, turn out to have been built on shaky foundations. And it stresses the importance of keeping eyes on the real goals – success for a provider is in no way defined by achieving foundation trust status, but in delivering high quality, effective care.

As we read the Francis report, we need to think about how we can be better at what we do and challenge our own behaviour. Have we ever set undeliverable budgets, for example, or offered undeliverable contracts? The report suggests that some ‘in responsible positions’ were not ‘sufficiently sensitive’ to the implications for patient care and standards of care. My theme for this year in part speaks to this agenda. ‘Knowing the business’ is about finance practitioners getting a better understanding of how clinical services are delivered.

As the HFMA has said before, engagement between clinicians and finance is vital if we are to deliver same and better quality services within a difficult financial environment. Part of this is about understanding each other’s business. But it is also about keeping patients front and centre in our thinking.

Robert Francis argues that a ‘relentless focus on the patient’s interests’ is what will deliver the ‘shared positive culture’ needed across the whole service. Achieving this will not require radical reorganisation, he says, but a ‘reemphasis of what is truly important’. We should keep this in mind.

We await the formal response by the government to the report. No doubt there will be some significant changes around inspection, regulation and transfer of responsibilities. But perhaps the most important changes will be the small changes made by all staff – front line and in support roles such as finance – as they seek to apply the Francis findings and recommendations as part of their own day-to-day activities.

You, your family and friends may – either now or in the future – rely on the NHS, so listening to Francis should feel personal to us all.

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