Implementing the recommendations of the Francis Inquiry the RCP response. Sir Richard Thompson President Royal College of Physicians

Transcription

1 Implementing the recommendations of the Francis Inquiry the RCP response Sir Richard Thompson President Royal College of Physicians

2 The Francis inquiry recommendations! Aligning culture with patient needs Openness Rapid response to errors Healthcare standards? Better regulation Individual leadership & accountability Better information & sharing 2

3 Francis Robert Francis: Fundamental culture change DH, Hard Truths, 2013: Hear the patient, speak the truth, and act with compassion Blind adherence to targets or finance must never again be allowed to come before the quality of care 3

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5 Hospitals on the Edge?-2012 Inexorably rising acute clinical demands Changing needs Lack of continuity of care EWTD & New Deal Poor out-of-hours care Higher mortality of admissions at w/e Medical workforce crisis 5

6 RCP Future Hospital Commission 2013 High quality care 24/7 Acute consultants 12/7 Fewer patient ward moves Responsible consultant Generalists interfacing with specialists Consultants working in the community Medical team & family organise transfer Chief of Medicine 6

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8 Stephen Dorrell: Where were the doctors when things were bad? Were consultants and more importantly, trainees on the failing wards? Yes! Did they protest? No! Did the system prevent them? Probably! 8

9 RCP leading the Profession Consultant on site 12/7 (2010) Weekend ward rounds (2010) Consultant buddy with ward sister Strengthen role of ward sister Improve staff well being & morale Support doctors in management roles Shared decision making 9

10 Regulation RCP working with new CQC Elder friendly ward quality mark Hospital health checks by triangulation Service accreditation across specialities Clinical consultancy for hospitals Hospital ratings? Foster an attitude of support Regulation of managers, HCAs & PAs 10

11 Service accreditation RCPsych, RCPath,RCoA RCP-JAG Physiological diagnostics Occupational medicine Immunology & allergy Hepatology Pulmonary rehabilitation CQC interested 11

12 Leadership Motivating Inspiring Prompting Coaxing Flattering Setting standards Exemplifying standards 12

13 Poor leadership Military - clear lines of responsibility: Amritsar massacre, India, 1919 Abu Ghraib prison, Baghdad, Marine Sergeant Alexander Blackman, Afghanistan, 2013 So where were the officers? 13

14 Lack of leadership in NHS Systemic bullying & intimidation By DH & NHSE West Midlands SHA (Mid-Staffs) Lincoln Influenza immunisation Graham Pink, Stepping Hill, 1990 Financial incentives & disincentives 14

15 Malcolm Gradwell: Genetics & parents are less important than peers in influencing behaviours Hence medical & nurse leaders must influence colleagues -and also be responsible for any poor care 15

16 Undermining Bullying of staff BMA survey nurses on trainees FMLM survey of trainees RCP CMT survey Bullying by management 16

17 Annual appraisals Whistle blowing Raising concerns Complaints Embedded in annual appraisals Mandatory rather than optional (GMC) Discussed and supported by appraisers Welcomed by managers 17

18 Compassion You can t legislate for goodness BMJ How can I be compassionate if I am looking after thirty patients? In the right circumstances we can all lapse and be cruel Criminal wilful neglect? Who is being deliberately uncaring? 18

19 Duty of candour RCP opposes statutory & criminal Shared decision making Local culture of openness No recrimination Usually failure of system & not individual Report in annual appraisal Make use of responsible consultant Root cause analysis of events Report to Trust Board 19

20 Compassion Moralistic rhetoric extolling the virtues of this noble and uniquely human quality -Sean Roche But how to diffuse it? In order for patients to be valued, we must begin by valuing staff NHS staff are all angels, but not all of them all the time 20

21 Saying sorry NHS Litigation Authority Verbal & written apology by staff Without delay Not an admission of liability Communication Support, encourage & help staff Second victim of incident Responsible consultant and sister 21

22 Proposal Two patients and an elected consultant on Trust board, responsible for concerns and culture in organisation They must breakdown the culture of scrutiny, targets and anxiety 22

23 Patients comments Collected when patients leave ward or clinic By nurse, HCA, pharmacist etc Collated by Sister Transparent Results from wards or clinics compared Learn from best results 23

24 Responsible consultant Continuity of care Not passed around like a package Number one desire of patients Responsible for overall pathway of care; helmsman Not accountable for all clinical decisions Responsible, with nursing sister, for following up all clinical concerns Daily names over bed 24

25 Trainee doctors Responsible professionals Eyes and ears of hospital- Robert Francis Often the only doctors on wards Trainees committee CEO should meet them regularly Chairman- annual dinner for registrars Trainee on Trust Board 25

26 Shape of Training More training in general medicine & whole person care More speciality registrars to dual train in speciality & GIM Certificate of Specialist Training (CST) Credentialing thereafter Different models for different hospitals 26

27 Support for Health Service Praise for efforts of staff Understanding complexity and grind of health care Realisation of difficulties facing staff - day in, day out Patients want to be cared for by staff that are treated well - Jeremy Taylor from Whitehall to Trusts 27

28 Manslaughter RCP strongly opposes Usually negligence, ignorance, systemic etc Not wilful, nor intended Professional punishment (GMC) Deeply demoralising for other staff Pour encourager les autres - Voltaire, Candide eg Sergeant Blackman Mr David Sellu 28

29 A promise to learn-a commitment to act NHS staff are not to blame It is the systems, procedures, conditions, environment and constraints they face Fear is toxic to both safety and improvement Abandon blame as a tool Trust the goodwill & good intentions of the staff Reassert the primacy of working with patients and carers Make sure pride and joy in work, not fear, infuse the NHS Use quantitative targets with caution Don Berwick,

30 We should celebrate the success of the NHS Outcomes are much improved A world leading example of commitment to health and health care-as a human right It is fine institution Don Berwick,

31 Thank you 31

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34 Never events Unhelpful to label them unacceptable Of course must be minimised Learn from mistakes Emphasise procedures to prevent them - but note annual SHOT reports 34