AHPs, the Francis report, Cavendish and Keogh

Since the publication of the Francis report (http://goo.gl/XPLTU) the nursing profession has come under fire quite unfairly when you consider the approach that should be taken in hospital settings in terms of teamwork (see http://goo.gl/OROrXX for the WAG guide: Multidisciplinary practice: A framework for practice in Wales) and perhaps most invidiously the drivers of healthcare which measured the Mid Staffs Trust’s performance targets but not the quality of experience of service users and its duty of care. Volume 1 of the Francis report summarises the problems as follows:
• There was a lack of basic care across a number of wards and departments at the Trust;
• The culture at the Trust was not conducive to providing good care for patients or providing a supportive working environment for staff; there was an atmosphere of fear of adverse repercussions; a high priority was placed on the achievement of targets; the consultant body largely dissociated itself from management; there was low morale amongst staff; there was a lack of openness and an acceptance of poor standards;
• Management thinking during the period under review was dominated by financial pressures and achieving foundation status, to the detriment of quality of care;
• There was a management failure to remedy the deficiencies in staff and governance that had existed for a long time, including an absence of effective clinical governance;
• There was a lack of urgency in the Board’s approach to some problems, such as those in governance;
• Statistics and reports were preferred to patient experience data, with a focus on systems, not outcomes;
• There was a lack of internal and external transparency regarding the problems that existed at the Trust.
Looking at the stories of the patients and their families (see http://goo.gl/AnXKS) it is impossible to believe how the Trust managed to gain Foundation Trust status in February 2008. To summarise:
• Assistance was not provided with feeding for patients who could not eat without help;
• Water was left out of reach;
• In spite of persistent requests for help, patients were not assisted in their toileting;
• Wards and toilet facilities were left in a filthy condition;
• Privacy and dignity, even in death, were denied;
• Triage in A&E was undertaken by untrained staff;
• Staff treated patients and those close to them with what appeared to be callous indifference.
The stories from staff are also distressing and provoke a real sense of frustration: staff cuts, reported in terms of impacts on patient safety and duty of care were ignored and no changes made; staff were blamed for working inefficiently and not meeting targets; staff were told to take breaks whatever the problems on the ward rather than addressing the fact that there were insufficient staff to take said breaks. In simple terms staff had the knowledge that care was inadequate AND reported this but it was ignored. A bullying culture on the wards with fear of reprisals was a real problem; there was no clinical leadership, poor practice became the norm and was the accepted culture of the hospital. When this was challenged people were asked to accede or leave!
Amongst all of this distressing feedback in the Francis report the AHPs part in the activity remains rather vague, if not absent and in one sense, almost absolves their role. Yet thankfully the question of why their part in Mid Staffs was not included has been asked many times and this link http://goo.gl/OV3PP takes you to an interesting debate on just this issue by Karen Middleton, Chief Allied Health Professions Officer (England). She advocates that we do recognise our part in this and all AHPs, should embrace the 6c’s developed by our nursing colleagues. Why invent our own caring values, she remonstrates when the nursing profession have produced something we can share? There is also a Webinar chaired by the chief executive of speech and language therapists (SALTs) with Karen Middleton, (as above) Julia Scott, CEO, College of Occupational Therapists (COT) and Anna van de Gaarg, chair, HCPC at http://goo.gl/vb63EY which is worth listening to albeit its poor sound quality.
Harrowing as the Francis report is, there is hope that a service and staff group starved of care and compassion by successive governments (including New Labour who put in money but drove up performance targets) might now actually be getting some positive inputs and the performance value culture might change. The recent Cavendish report (2013) (http://goo.gl/3bDYAT) advocates more training for healthcare assistants and appropriate skill mix on the wards, with higher levels of qualified staff. Keogh (2013) (http://goo.gl/pYyg5h) is driving real change to address quality in the NHS and does this is a meaningful way. He does not blame staff rather he argues for listening to and involving service users at all levels of the organisation and its decision making process; appropriate use of data and research; excellence in the Care Quality Commission reports and, hallelujah a caring and supportive environment for staff. The Council of Deans response to the Francis report (http://goo.gl/OvRJTs) notes that if you value staff, their hearts as well as minds will follow and a caring and committed approach to work predominate. These reports offer hope and a very positive perspective of care and commitment to staff as well as service users. But the question is, can, or indeed will, a Government committed to market cultures and productivity do it? Or will the usual rhetoric prevail and political power and dictate create yet another performance AND cuts driven monster? What then do we as care workers do? This takes me back to Margaret Wheatley and a previous blog in which she notes the need to work “under the radar” of performance driven management ken in the creation of a positive learning and relational driven environment and to “proceed until apprehended”. In caring for service users and colleagues this is the least we can do and that might lead to real change. As the Scottish mountaineer William Hutchinson Murray (1951) famously said: “What you can do, or dream you can, begin it. Boldness has genius, power and magic in it.”
Cavendish C (2013) Cavendish Review: an independent review into healthcare assistants and support workers in the NHS and social care setting, England, DoH. Online available at: http://goo.gl/3bDYAT
Keogh Report (2013) Review into the quality of the care and treatment provided by 14 hospitals in England, London, NHS
Murray (1951) The Scottish Himalayan Expedition, London, Dent

2 thoughts on “AHPs, the Francis report, Cavendish and Keogh”

  1. Interesting read 🙂 Good to have a summary of the report as it is rather lengthy!!!
    Would agree that just because AHPs are not in the report it does not make us blameless. Have had a few OT students in our dept recently who have said some worrying things “why should we get them water, that’s the nurses job”…needless to say we put them right! But agree that students (and AHP students) would probably benefit from HCA training prior to employment! We have all recently been on HCA training and I found it very helpful!! thanks for sharing! 🙂


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