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The Francis report into the Mid Staffs NHS Trust dominated the headlines and reignited
the debate about health service provision. But what are the likely implications for the
substance use sector, asks
DDN
News focus |
Analysis
THE FRANCIS REPORT: WHAT ABOUT
DRUG AND ALCOHOL SERVICES?
6 |
drinkanddrugsnews
| March 2013
www.drinkanddrugsnews.com
Called the ‘worst scandal in the history of
the NHS’, the appalling neglect of patients at
the Mid Staffordshire NHS Foundation Trust
led to a public inquiry chaired by Robert
Francis QC and, last month, the publication
of his vast and damning report, weighing in
at nearly 2,000 pages over three volumes.
‘There were and are a plethora of agencies,
scrutiny groups, commissioners, regulators and
professional bodies, all of whom might have been
expected by patients and the public to detect and do
something effective to remedy non-compliance with
acceptable standards of care,’ wrote Francis to health
secretary Jeremy Hunt. ‘For years that did not occur.’
His report calls for a system that ‘recognises and
applies the values of transparency, honesty and
candour’, and contains nearly 300 recommendations
that he wants to see ‘all commissioning, service
provision, regulatory and ancillary organisations in
healthcare’ consider and apply to their work.
But how much are those in the substance
misuse sector likely to feel the fall-out from the
report? ‘It is largely NHS-focused so if there are
services which are run within the NHS then they are
going to know about it,’ says social care consultant
and
DDN
contributor David Finney. ‘With, say, the
detox services and maybe even any other services
that receive NHS funding, there’s probably going to
be additional demand on them to make sure they
listen to patients or service users. Because the fact
that all these families had people who’d received
such awful care was the major thrust for getting the
Francis report going.’
The last time the CQC was subject to a barrage
of criticism – in the wake of the equally shocking
Winterbourne View scandal in 2011 – part of its
response was to toughen up its inspection regime.
Does this mean they’re likely to do so again? ‘I think
they will,’ he says. ‘But the only danger is they’ll
focus so much on the hospitals that they might stop
focusing on the rest of their regulatory function.
That’s a possible problem.’
One potential outcome, however, is the creation
of a more level playing field between NHS services
and independent, voluntary services, he explains, as
while social care regulation is currently ‘quite robust’
the regulation of the NHS has been more distant –
‘more statistic-based, rather than getting in there
and finding out’.
Responding to the report, the Faculty of Public
Health stated that all health professionals must ‘have
the confidence to speak out if they are concerned that
patient care is being compromised’. The report itself,
however, wants to see an enforced ‘duty of candour’,
making it an offence for staff not to report their
concerns (although in the case of Winterbourne View
it was the BBC’s
Panorama
programme that exposed
what was going on, the CQC having ignored the
concerns of a senior nurse who contacted them). Is
the recommendation practicable, given how whistle
blowers tend to be treated by their employers?
‘That will require a culture change in whatever
organisation is being complained about, but if it’s
got to the stage of whistle blowing then something’s
obviously gone badly wrong,’ says Finney. ‘I hope it
works. I hope people realise they’re responsible,
because again it’s the lack of a level playing field
between NHS services and independent services –
the registered manager and the nominated individual
are directly accountable and can be convicted of a
criminal offence for not doing those things, whereas
in the NHS they didn’t have those similar people
appointed. So it is really just levelling the playing
field and highlighting the fact that it’s got to be done,
because the [Mid-Staffs] patients and families are
naturally angry that nobody’s been brought to book.’
The report also describes a lack of openness and
transparency throughout the system. Is that true on
the substance misuse side of things – do those things
already exist, or does this need to be worked on
more? ‘I think there’s always scope for working on that
more, but it is there. But I think this just sharpens the
minds of the CQC that they really do have to do that.’
The report is fairly damning about the CQC,
however – branding it defensive and opaque, among
other things. Is that fair? ‘I think it is fair, although
that was more in the days of [CQC forerunner] the
Healthcare Commission I think,’ he says. ‘I think
there is a lack of transparency – a lot of the services I
work with aren’t clear about how the CQC are going
to go about their business, and sometimes they’re
not clear about how they’ve made their judgements,
as it’s not immediately obvious. But I don’t think the
substance misuse sector has suffered a great deal
under the CQC. I’m not picking that up, anyway.’
Another focus of the report is around leadership
and direction. Having a chief inspector of hospitals,
as Francis recommends is ‘an interesting proposal’,
says Finney, as it would bring a higher profile to
regulation. ‘But the CQC now have this guy David
Behan as chief executive, who is excellent – he’s got
vision and he’s someone who gets things done. In his
past life he used to be a chair of a DAAT in one of the
London boroughs, so I think it’s brilliant having him
on board. I’m sure he still understands the substance
misuse sector and has an empathy for it.’
Report of the Mid Staffordshire NHS Foundation Trust
public inquiry at www.midstaffspublicinquiry.com
‘With, say, the detox
services and maybe
even any other
services that receive
NHS funding, there’s
probably going to be
additional demand on
them to make sure
they listen to patients
or service users.’
DAVID FINNEY