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Mid Staffs report is right: NHS targets went too far Mid Staffs report is right: NHS targets went too far
(7 months later)
For anyone who cares about the NHS, the Francis report into care failings at Stafford hospital makes difficult reading. It lays bare a betrayal of everything the NHS stands for. The most immediate danger is of responding in the wrong way. Those close to the NHS may seek to minimise the report, returning to business as usual. Detractors may use this moment to run the NHS down, proposing knee-jerk corrections. Either would be profoundly wrong.For anyone who cares about the NHS, the Francis report into care failings at Stafford hospital makes difficult reading. It lays bare a betrayal of everything the NHS stands for. The most immediate danger is of responding in the wrong way. Those close to the NHS may seek to minimise the report, returning to business as usual. Detractors may use this moment to run the NHS down, proposing knee-jerk corrections. Either would be profoundly wrong.
The NHS has improved over the past decade. But in places a worrying culture has developed over many years, with disastrous consequences at Stafford. It is only by facing up to that, and learning the deep lessons of Robert Francis's report, that the NHS will continue to earn the respect of the public. That's why I am putting the report, its analysis and recommendations, at the heart of Labour's health and care policy review, which starts this week. This is more difficult than it sounds, because it means challenging assumptions that have underpinned health policy in recent years.The NHS has improved over the past decade. But in places a worrying culture has developed over many years, with disastrous consequences at Stafford. It is only by facing up to that, and learning the deep lessons of Robert Francis's report, that the NHS will continue to earn the respect of the public. That's why I am putting the report, its analysis and recommendations, at the heart of Labour's health and care policy review, which starts this week. This is more difficult than it sounds, because it means challenging assumptions that have underpinned health policy in recent years.
I draw three central lessons from Francis, starting with NHS culture. Over the past 20 years, there has been a drive to import a commercial mentality into the NHS, which has given rise to a new managerialism and a focus on finance and targets. This approach may be well suited to retail, but there are limits to how far it can be applied to healthcare. On the plus side, it has helped to reduce waiting times and make hospitals more efficient. But in places the response was a tendency to focus on numbers, not people.I draw three central lessons from Francis, starting with NHS culture. Over the past 20 years, there has been a drive to import a commercial mentality into the NHS, which has given rise to a new managerialism and a focus on finance and targets. This approach may be well suited to retail, but there are limits to how far it can be applied to healthcare. On the plus side, it has helped to reduce waiting times and make hospitals more efficient. But in places the response was a tendency to focus on numbers, not people.
Francis is right to say targets, properly constructed and implemented, have a place. But he is also right to warn of an over-reliance on targets. This is a lesson Labour is learning. If we don't, the NHS won't be able to rise to the complex challenge of caring for older people – the second lesson from Francis.Francis is right to say targets, properly constructed and implemented, have a place. But he is also right to warn of an over-reliance on targets. This is a lesson Labour is learning. If we don't, the NHS won't be able to rise to the complex challenge of caring for older people – the second lesson from Francis.
He is right to ask us to rethink from first principles the way older people are treated. Stories of older people lost in acute hospitals – disorientated and dehydrated – have become commonplace. I have thought carefully about why this is happening.He is right to ask us to rethink from first principles the way older people are treated. Stories of older people lost in acute hospitals – disorientated and dehydrated – have become commonplace. I have thought carefully about why this is happening.
The World Health Organisation defines health as "a complete state of physical, mental and social wellbeing, not the absence of disease or infirmity". But for 65 years England has tried to meet one person's needs through three separate systems: physical, through the mainstream NHS; mental, through separate buildings on the fringes of the NHS; and social, through a council-run, means-tested system.The World Health Organisation defines health as "a complete state of physical, mental and social wellbeing, not the absence of disease or infirmity". But for 65 years England has tried to meet one person's needs through three separate systems: physical, through the mainstream NHS; mental, through separate buildings on the fringes of the NHS; and social, through a council-run, means-tested system.
As we live into our late 80s and 90s, our needs become a complex blur of the physical, mental and social. But our hospitals are only geared up to deal with some of these needs, explaining why so many frail people go downhill quickly on admission. Francis recommends new ways of working in hospitals to prevent this: a single clinician in charge of one person's care; a nursing role focused on older people. I welcome these suggestions, but propose we go even further and consider the full merger of health and social care.As we live into our late 80s and 90s, our needs become a complex blur of the physical, mental and social. But our hospitals are only geared up to deal with some of these needs, explaining why so many frail people go downhill quickly on admission. Francis recommends new ways of working in hospitals to prevent this: a single clinician in charge of one person's care; a nursing role focused on older people. I welcome these suggestions, but propose we go even further and consider the full merger of health and social care.
With the NHS responsible for social care, new possibilities open up. For instance, if an older person is admitted, a known care worker follows from home to provide support on the ward, providing huge reassurance for families increasingly fearful of mum or dad going into hospital.With the NHS responsible for social care, new possibilities open up. For instance, if an older person is admitted, a known care worker follows from home to provide support on the ward, providing huge reassurance for families increasingly fearful of mum or dad going into hospital.
Whole-person care is the proposal I am putting at the heart of Labour's policy review. I do so mindful of Francis's third lesson: how to make change in the NHS. He is surely right to say perpetual reorganisation has taken the focus off patient care and that Whitehall is too detached from the consequences on the frontline. Politicians have dropped policies from a great height on an unsuspecting NHS weeks before elections – or, in the case of the last one, weeks after. So I am putting my ideas on the table now, as I want time to build the policy with patients and the professions before we put it before the country in 2015. It is why I have also said that I will work through the bodies we inherit and will not engage in another top-down reorganisation.Whole-person care is the proposal I am putting at the heart of Labour's policy review. I do so mindful of Francis's third lesson: how to make change in the NHS. He is surely right to say perpetual reorganisation has taken the focus off patient care and that Whitehall is too detached from the consequences on the frontline. Politicians have dropped policies from a great height on an unsuspecting NHS weeks before elections – or, in the case of the last one, weeks after. So I am putting my ideas on the table now, as I want time to build the policy with patients and the professions before we put it before the country in 2015. It is why I have also said that I will work through the bodies we inherit and will not engage in another top-down reorganisation.
Over the next six months, the shadow health team will be undertaking a programme of work-shadowing NHS and social care staff to develop a deep understanding of people's ability to deliver the change the NHS needs.Over the next six months, the shadow health team will be undertaking a programme of work-shadowing NHS and social care staff to develop a deep understanding of people's ability to deliver the change the NHS needs.
In just a few months' time, the NHS will be 65. It is time for it to enter a new phase of its life. Robert Francis has given us a cue to start that work in earnest.In just a few months' time, the NHS will be 65. It is time for it to enter a new phase of its life. Robert Francis has given us a cue to start that work in earnest.
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