The Francis Report – why it matters for The Medical School and for you as students ….

The final report of the Mid-Staffs Public Inquiry (known as “The Francis Report”) was published on Feb 6th 2013 (http://www.midstaffspublicinquiry.com/report).  The report was instigated by the Secretary of State for Health in an attempt to explore the reasons behind an excessive number of deaths – estimated to be somewhere between 400 and1200 – that arose from a failing NHS Hospital Trust in the mid 2000’s. The report is extremely detailed being over 2000 pages long; the executive summary alone is over 120 pages and has as its heart 290 specific recommendations designed to prevent a recurrence of this appalling failure of patient care. Patient suffering on an unprecedented scale is blamed primarily on failures of the NHS Hospital Trust board and its managerial and leadership abilities. However, wider flaws in “institutional culture” that placed finance and NHS targets ahead of the needs of patients and wider issues of poor communication with external agencies and watch-dog organisations are also highlighted by the investigation. It is a report that all of us who are involved in the clinical care of patients must take to heart and should provoke an inward look at each of our own professional values, and allow us to reflect on what structures should underpin state-of-the-art patient care. An important part of the report is levelled at the medical/ healthcare professional staff and the specific challenges of ensuring that the correct culture is in place across medical teams. It will act as a reminder to everyone of the importance of putting patients first.

This phrase, much used in the media in recent days, is at the heart of the report.  Of course we would all agree, but what does this actually mean for you and your training as a medical student? 

As you will be well aware, the Dean’s team has focussed for many years now on the importance of your own personal qualities and core values; indeed this process begins during welcome week at the Medical School. This is not only about communication skills, dedication, and team-working (attitudes and skills which we embellish throughout your training), but the core qualities of being a caring individual including empathy and inner resilience. Post Francis there are now additional responsibilities that we will be emphasising.  One of the Recommendations is that the GMC should require “providers” to “actively seek feedback from students and tutors” on whether hospital placements meet minimum standards of patient safety and quality of care.  Another Recommendation talks of the need for “Proactive steps….to be taken to encourage openness on the part of trainees” (i.e. doctors in training). 

We all have a responsibility to be aware of patient safety issues, and to make others aware of shortcomings if we see them.  “Openness” means that none of us, whether we are medical students, junior doctors, senior consultants or practicising Deans, tries to hush things up.  And it also means that there are no repercussions if we identify a problem.  The message of Francis is “openness, transparency and candour throughout the system”. As far as your tutors in the Teaching Academies and the Medical School are concerned, it’s our responsibility to make it as easy as possible for concerns to be aired.  We will therefore ensure that there are occasions when we ask directly if you have observed anything that worries you in clinical placements. 

As Francis makes clear, there are plenty of “systems” in place to monitor health care professionals and their workplaces.  But these systems can only function well if the culture of the workplace is right.  We all have a part to play here too, as students, doctors or tutors.  We need to promote a culture in which everything we do or say is for the benefit of patients.  This doesn’t just mean prescribing the right drug.  It means being alert to what is going on around us, not accepting poor standards in ourselves or others, and raising concerns where we need to. Putting the patient first must be at the bedrock of everything we do in our clinical life and accepting a personal responsibility to ensure that this is the case will go a long way to preventing another Mid-Staffs catastrophe.

John Skelton
Paul M Stewart
20th Feb 2013

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