Will the Francis report address the need for new leadership skills to prevent abuse?


Keith BrownWill the Francis report address the need for new leadership skills to prevent abuse?

Professor Keith Brown, Director of the National Centre for Post-Qualifying Social Work

Jeremy Hunt, speaking at the chief nursing officer’s conference at the end of last year, said that poor care such as that found at the Mid Staffordshire Foundation Trust, should not be tolerated and many involved in the Caring Professions eagerly await the pending Francis report.

Jeremy Hunt warned delegates that the Francis report into the care and governance failings at Mid Staffordshire

“was going to be a very big moment and a very difficult moment for the NHS with respect to the public.”

He added:

“What we mustn’t do is say that Mid Staffs itself was an exception, because there are unfortunately pockets of those problems – even if not in that concentration – throughout the country.  They are a betrayal of the other nurses and doctors, clinicians and care workers in those hospitals, the majority of whom will be working extremely hard and doing a very good job.”

Keith Brown Telegraph francis reportOn New Year’s Day, the Telegraph published an article about the abuse culture in hospitals and I was quoted saying that new leadership skills are needed, focused on the care sector rather than financial management.

The response generated by this article is both astounding and reassuring.  This country cares deeply about our hospitals and care homes.  Nearly 600 comments were left on this article by everyone from doctors and nurses and leaders in the profession to patients and families of patients.

Of course the article provided a focus for a number of well-worn arguments, blaming the problems on degree nurses, too many overseas nurses and a lack of staff.  And there were considerable discussions around whether people are born caring and whether training should ever be needed to help people be compassionate.

But there were thoughtful comments too and above all a strong sense that leaders must now take responsibility for the culture of abuse and bullying that appears to have become endemic.

Perhaps the biggest concern – and the one that our team has been concerned with for some time – is that it is clear that whistle-blowing is not working.  There were too many comments about individuals who had raised the alarm about abuse and then became the person blamed – and the abuse not dealt with, and from other staff genuinely too afraid to whistle blow due to the culture of their organisation.

One comment particularly resonated with us:

“How do you teach the courage to stand up and be counted? To blow a whistle and not yourself be sacked and shunned. There needs to be a culture of those who have concerns in any of these behemoths, being able to sound a loud and clear alert in the right place – and then for something actually to be done, rather than lessons learned and carry on as before but with the troublemaker sacked.”

There was a running theme that nurses and carers are sick of targets.  But then there was one very sensible comment saying that it’s not targets themselves that are wrong, but what we are measuring – and suggesting that we should focus on the quality of the care as perceived by patients and carers.

I personally came in for both heavy criticism and praise – with quotes ranging from‘the first sanity of the year’ to unrepeatable comments about academics and our lack of understanding of the practical issues faced in hospitals and care homes.  I should say that I spend most of my time working in and with over 80 Local Authorities and over 20 NHS Trusts across the UK, working with leaders and practitioners to improve the performance of their organisations – and measuring the impact of this training to ensure it has made a significant impact.

The issues around the Francis report were summed up in this comment:

“Everyone’s behaviour is a reflection of the culture of the organisation they work for. How else could it be otherwise?  Nurses are no different. If we want them to give of their best, to give the maternal care which should come naturally, we must change the culture. And since the NHS culture reflects that of the nation, this is not an easy thing to do.”

This is spot on.  Surely the fastest and most effective change will come if we ensure that leaders [and all professionals have some leadership responsibility if only for the patients/clients they are providing care for i.e.  it’s not just the Senior Managers]  have the skills needed for care organisations and understand exactly how you create a caring culture and prevent abuse?  That has to be more effective than saying nurses do or don’t need degrees and blaming everyone from the government to targets.

Continuing with the blame game will not solve these problems – Effective Leadership Development for all professionals which changes organisational culture surely is both a solution and also a valuable use of energy, time and resources.