Kicking an institution already reeling from exposés of their failings seems to be the mode du jour, at least if the UN’s recent dressing down of the Vatican is anything to go by. All our institutions are under scrutiny and criticism like never before, not just the church (of all ecclesiastical flavours), but everything from the Police to the BBC to Parliament, and not least of all, the National Health Service.
One year ago today (6 Feb 2013), Robert Francis QC published his seminal report into what went wrong at Mid Staffordshire NHS Trust. This report has stood as the turning point in how we perceive the British National Health Service, with more and more reports coming out all the time about how care and compassion have broken down, how a fixation on targets has led to patient neglect, how the professions were failing, the regulatory bodies were failing…
We could go on to list all the failings, but this has been done before, ad nauseum. The bigger question is what has actually changed in the last twelve months?
The Nuffield Trust today launched a report that shows most NHS Trusts are taking on the core recommendations of the Francis Report, but finding the current funding climate holding back many of the reforms that they want to bring about. The report remains optimistic that at least improving care standards is more central to the thinking of trust management.
This reminds me of Sally Hawkins’ line to her husband played by Daniel Mays in ‘Made in Dagenham’. When he pleads that he is not like the other husbands, as he is not going out drinking away her earnings and then coming home to beat her and the kids, she rightly turns round and says ‘that’s as it should be Eddie!’. Making care of patients central to the thinking and planning of NHS trusts is, surely ‘just as it should be’! But, at least the recognition that the main thing is the main thing is the first step in the right direction.
The Nursing Times recently polled its members to ask how they felt the post-Francis reforms were going. The results suggest that not much is actually changing on the ground. Yet interestingly, the majority of nurses seemed optimistic that changes were coming, but meanwhile they were still struggling with under staffing and too high a proportion of care assistants to trained nurses.
Most opinion pieces written by health professionals and managers in the press right now suggests that most of those working in the system see the need for change and have a desire to make it happen. What they lack is staff and funding to bring about that change as swiftly or effectively as they (and we) would like.
I have blogged before about the dangers of a top-down approach to change – including more punitive regulation. The impression the press give us is that the NHS is a failing institution, staffed by uncaring technocrats (including the nursing and medical staff) that needs tearing down and rebuilding. Meanwhile, the professions paint a picture of dedicated NHS staff struggling with a lack of resources and overbearing regulation.
The truth, as ever, lies between such caricatures. There is an institutional culture in the NHS that has gone off track, and no amount of legislation or regulation will change this. It corrupts, holding back or bullying those who seek to challenge what is wrong, pushing down those who seek to care. But there are as many examples that buck this trend as much as succumb to it (possibly more). And there does seem to be a surprising reservoir of good will and willingness to change within the NHS. However it is a huge institution (the biggest employer in the UK, and one of the ten biggest employers on Earth). It will take years to implement real change, and in a system still reeling from the reforms of the Health and Social Care Act, the post-Francis reforms are going to take that much longer to institute.
The strength of a society is based in large part in the health and strength of its institutions, and in the UK the NHS is one of the most vital, and loved institutions. It is not just down to government or the professions to seek its reform and wellbeing. It is our collective responsibility. We, as a society, need to be supporting our doctors, nurses, health managers and other NHS staff, not attacking any one group or another. We need as churches to be particularly supporting those in our local community and congregations working to change the system. One year on from the Francis Report, the surface has not changed appreciably, and there is a lot still to do, but that is not cause for despair or recrimination. Rather it should spur us on to pull together to create a caring, compassionate and effective NHS.