The role of professional regulation after the Francis inquiry

Last week I attended the King’s Fund conference looking at the outcomes of the public inquiry into the failures in care at the Mid Staffordshire NHS Foundation Trust.

The conference was an opportunity for all those with responsibility for health and social care (from funding, to delivery, to regulation and oversight), to come together to continue the process of exploring the fundamental question after any public inquiry – what now?

What will endure with me most in Robert Francis’ opening presentation were the patient stories – the first-hand accounts of truly appalling care. As Robert Francis emphasised, on the whole these were not examples of deviation from good practice, but ‘obvious’ failures in the fundamental standards of care which we should all expect.

Culture and culture change was a consistent theme throughout the day. Robert Francis spoke about the development of a culture at Mid Staffordshire where patients and staff were either not listened to or felt discouraged or disempowered to speak up. A number of the participants in the audience were former NHS staff with a poor experience of reporting and escalating instances of poor patient care. They were keen to ensure that the inquiry led to real change in how whistleblowers were treated and supported, from the actions of the Board in setting the tone for how reports of poor standards were handled, to how whistleblowers were treated by their peers. At times there was a hint of weariness from some in the audience – a fear that reducing the problem and solution to intangible references to culture would be a blueprint for inaction. We were reminded by Robert Francis at the beginning of the day that many of his recommendations could be implemented now and without the need for legislation, there was no need for delay.

So, what role do professional regulators have to play in a ‘post Francis world’? The challenge from Robert Francis was for all organisations to reflect on the report; to evidence their acceptance of the report’s recommendations; and to take effective steps to translate that acceptance into real action. Our Council will begin that process with a paper at its next meeting in a few weeks’ time.

Some of the changes we might need to make are immediately apparent. For example, we have begun the process of reviewing our standards of conduct, performance and ethics and we know as part of that we will want to strengthen our existing requirements about the responsibility of our registrants to report and escalate concerns about poor care. This will build on our existing commitments as part of the NHS Employers Speaking Up Charter. We will also want to continue encouraging and engaging in debates with health and care professionals about professionalism. Francis spoke of a conversation with one professional who described the process of becoming ‘immune to the sound of pain’ in an atmosphere of intense pressure, low staffing levels and even lower morale. How do health and care professionals and their leaders address this kind of pattern?

We need to think about both the role we play as a regulator in setting standards for a range of health and care professionals, and the role this plays in helping to shape the culture. But we also need to think about the wider lessons we can learn from the Francis report for us as an organisation.

We were reminded last week that professional regulation is only one part of a wider jigsaw puzzle that collectively ensures quality and safety, but that certainly shouldn’t exempt us from thinking about the part we can play in taking the ‘post-Francis’ agenda forward. And in doing so, the personal stories of pain and suffering should be uppermost in all of our minds.

Michael Guthrie
Director of Policy and Standards