Report “has enabled politicians to indulge in characteristic evasion”
The Francis inquiry into what happened at Mid-Staffordshire “has allowed the government to blame frontline clinicians rather than those in charge,” claims the former NHS chief executive David Hands, in this week’s BMJ.
Professor Hands says he finds it “astonishing” that Francis “focuses blame on the local trust and professional behaviour” and “provides little more than embellishment of the facts established in his first report.”
This myopia “has enabled politicians to indulge in characteristic evasion.”
As an example of the ‘culture of fear’ identified in the two Mid-Staffordshire inquiries, Hands criticises the practice of Sir David Nicholson, Chief Executive of the English NHS, of commissioning inadequate ‘reviews’ by management consultants in response to legitimate concerns of whistleblowers. “These ‘superficial exercises’ inevitably find ‘no evidence’ to warrant full investigation,” he says.
He describes his own experience of such a review after he reported concerns made by staff at Northamptonshire Healthcare NHS Trust, saying: “The self selected review team declined to interview any of the 70 potential witnesses I identified and concluded that no investigation was necessary.”
Yet, when giving evidence to the Francis enquiry in 2011, he says: “I was shown secret Department of Health papers that untruthfully recorded that my concerns had been fully and impartially investigated.” They also contained scurrilous innuendo about the clinical staff I had sought to help, he adds.
Hands also offered evidence of the “wider contextual influences on behaviour in Stafford” but says Francis “seemed uninterested in this broader evidence.”
Predictably, the government has acted quickly to devolve blame to the front line, to reinforce already top-heavy regulatory bureaucracy and to defend Sir David Nicholson, he writes. “How will these actions achieve the commonly shared values and open culture that Francis rightly identifies as crucial to the safeguarding of patients?”
The cultural change proposed by Francis requires leadership founded upon integrity and respect for others, underpinned by common values such as equality, accessibility, responsiveness, and, most importantly, outcome for patients and communities.
These are the values by which the NHS must be judged, concludes Hands. But, he says, government and the NHS chief executive “need first to remember their responsibility to be visibly committed to the Nolan principles for the conduct of public life: selflessness, integrity, objectivity, accountability, openness, honesty, and leadership.”
Personal View: “Francis inquiry has let the government off the hook”,
BMJ 2013;346:f2320 doi:10.1136/bmj.f2320