Government will need to make health policy U turns after Francis report, says safety expert

BMJ 2013; 346 doi: (Published 01 February 2013) Cite this as: BMJ 2013;346:f728
  1. Zosia Kmietowicz
  1. 1BMJ

Patient safety campaigners have called on the government to accept all the recommendations of the public inquiry into the events at Mid Staffordshire NHS Foundation Trust between 2005 and 2009 when they are published on 6 February, even if this means changing its current policy.

Peter Walsh, chief executive of the patients’ charity Action Against Medical Accidents (AvMA), said that there were some “pretty strong clues” as to what the report was likely to recommend from the closing statements of the inquiry’s chairman, Robert Francis QC, and the counsel to the inquiry, Tom Kark QC.

Many of the recommendations would be “contrary to the current direction of travel of the government,” believes Walsh. In a letter to Jeremy Hunt, the health secretary for England, Walsh asked for “an assurance that you will implement the inquiry’s recommendations in full” and that the “people and organisations most at fault for what happened at Stafford are held to account.”1

AvMA was a core participant in the inquiry and has supported many of the families who complained about the care at Stafford Hospital. Among the inquiry’s recommendations, Walsh believes, would be better regulation of the health service—along the lines of that in the aviation industry, which takes immediate action at the slightest indication that there could be problems.

Minimum staffing levels on wards were also likely to feature among the recommendations, said Walsh. In his summing up of the inquiry in December, Kark said that departments that could not adhere to guidelines on staffing levels “must be assumed to be providing an unsafe level of care and should accordingly be closed.”

At a press briefing on the letter on 1 February Walsh said, “Will Hunt be prepared to put patient safety before political ideology or is he really prepared to add insult to injury to the people who have lost loved ones due to the failure of standards and care of healthcare in this country.”

In the letter he said that the government’s decision to “plough ahead with its NHS reforms, regardless of what learning comes from the public inquiry, was a serious error of judgment. At the time we, along with many others, warned that there should have been an analysis of the implications for patient safety of the proposed reforms and that the public inquiry’s conclusions should be awaited.”

Walsh said that AvMA had become increasingly concerned about signals from the government that it might seek to sidestep or ignore any recommendations from the inquiry that it found unpalatable.

For example, Walsh believes that the inquiry is likely to recommend a statutory duty of candour that would require healthcare organisations to volunteer information to patients or their families about instances when patients were exposed to harm. But because the government has “pushed through” a “watered-down” version of a duty of candour, it would have to be seen to be making a U turn to comply with this recommendation, said Walsh.

The government announced in December that a duty of candour would become a condition in the NHS Standard Contract from April 2013.2 Walsh called the regulation a “throwaway line” that did not have the same weight as a legal requirement for openness and that excluded GPs and private providers.

Francis is also likely to recommend a better way of making patients’ concerns about the NHS heard, believes Walsh. New “Healthwatch” organisations introduced in the Health and Social Care Act start work in April 2013 to record patients’ experiences of health and social care.

But already “the government has pushed through controversial measures which will weaken and even muzzle Healthwatch,” said Walsh. He was referring to the fact that they are banned from campaigning, and he questioned what other means they could use to publicise poor standards of care. And because Healthwatch organisations are to be funded by local authorities—and this could end at any time—the government was “effectively guaranteeing [their] fragmentation and inconsistency,” said Walsh in the letter.


Cite this as: BMJ 2013;346:f728