Reading the Francis Report for many of us is like looking in a mirror. The mirror is at an angle, magnifying the perversities in the picture, but it is all recognisable. We see our NHS reflected back at us, the NHS in England in the early years of the 21st Century.

As the weeks since it was launched pass and the Francis Report fades rather too rapidly from the news headlines, there is little cause for cheer and much to dishearten. True, the concept of compassionate care is being bandied around in evangelical fashion and squeezed into every document possible. But frankly, there is an Orwellian touch to the way the word is being used and a real danger that the concept will be rendered trite and meaningless. Over the last few weeks, I have listened to an operating department assistant describe how he was dragged away from looking after a patient three times by an anxious manager wanting him to amend a form ticking boxes saying he was providing compassionate care to the patient; I have heard someone from the workforce planning department moaning about how busy he was having to amend job descriptions to include the word compassionate; and I have been approached by someone in medical education asking me to invent some exam questions that tested for compassion! more…

Medical ethics has positioned itself as a decision making tool, a philosophical spanner if you like in the clinician’s toolbox. For understandable reasons it has concentrated on practical dilemmas: even those landmark legal decisions—the removal of treatment from Anthony Bland comes to mind—are buttressed by intense philosophical scrutiny. In the process medical ethics has attracted some good minds from academic philosophy, pleased no doubt to see some practical pay-off from their more abstract deliberations. more…

Washington in spring is a visual treat, the spectacular arrays of cherry trees in bloom adding a frothy filigree to the sober magnificence of the iconic National Mall. Throw in blue skies and crisp spring weather, and it is not surprising that crowds flock to its Cherry Blossom Festival at weekends in March and April.

This vernal efflorescence provided a refreshing backdrop to the annual conference of the American Medical Directors Association (AMDA), the main organization for doctors working in nursing homes in the USA. The provision of formal guidance and continuing professional development to doctors in nursing homes is relatively underdeveloped in Europe , and the main organization for European geriatricians, the European Union Geriatric Medicine Society (EUGMS), has developed a special interest group to engage with the issue. more…

In an article in the Daily Telegraph, Gerry Robinson tells us that “fixing the NHS is straightforward.” He writes with optimistic alacrity of pragmatic, logistical, data-fuelled managerial devices to sharpen purview and performance. He cites management in McDonalds and Phones4U as good role models for healthcare. He conveys this as if it is bold and new.

I have been a frontline NHS doctor for more than forty years and my view is very different. In the last two decades we have had ever increasing infusions of such management modelling and corporate redesigns, based on what works in commerce and manufacturing industries. The resulting industrialisation of healthcare—and its guidance by the 3Cs: commissioning, competition, and commodification—has led to grievous loss of humane interest, attachments, and vocation in healthcare. The Mid Staffs debacle is one severe and grotesque consequent example. more…

The main focus of the recent Francis report has been on the implications it has on the clinical and economic management of the NHS, but there are many lessons that can be applied to all levels of hospital hierarchy.

Patient centred care is championed across healthcare, and nowhere as much as in complex care wards for older people, such as the one I’m currently placed on. The increasing number of admissions for older people with complex comorbidities and backgrounds means protocols and standardised treatments, although useful, are continuously being adapted for patients’ needs. more…

How could they have behaved like that? It’s inhuman!

Reading the Francis report, I was appalled and shamed by the neglect and lack of care to which patients in the Mid Staffordshire Foundation Trust were subjected. Remembering though, that this was human behaviour, prompted me to wonder at the circumstances that are necessary for so many people who (no doubt) regard themselves as good to behave so badly. more…

One of the most striking theatre productions I have ever witnessed was a riotous Polish play called Birthrate, the highlight of the 1981 Dublin Theatre Festival. Starting with a stage set resembling a train compartment, all was sweetness and light as the first few passengers entered, ceding place politely to a mother and baby. However, as more and more passengers piled in, tempers began to fray and civility eroded, to the point where the baby and the mother became the first to be ejected through the window. more…

One word that keeps being used in response to the Francis report into failings at Mid Staffordshire NHS Foundation Trust is “shame.”  Interestingly, it seems to be used more than “guilt” and most certainly more than “remorse.”  This is worrying because shame is particularly hard to process, an emotion that typically lurks around in individuals and organisations, making change and healing more difficult.  more…

The recommendations of the Francis Inquiry cannot simply be implemented. It is a complicated set of proposals that will create new difficulties and challenges for the medical profession. Doctors need to lead the debate on what happens next.

Robert Francis’s lawyerly circumlocution, filling almost 1,800 pages, guarantees that virtually nobody will read the whole report. Are public inquiry chairs paid by the kilogram? But at its core is the powerful concept of professionals adhering to “fundamental standards” to be enshrined in the NHS Constitution and health service regulations and policed by the Care Quality Commission. Crucially, Francis calls for “zero tolerance” of breaches. more…

The Francis Inquiry report rightly focuses on the need to transform the healthcare culture. It has made it clear that fault lines run throughout the NHS, from top to bottom, and that the inhumanity exposed at Mid Staffordshire is not restricted to that locality. The huge number of recommendations in the report (290) is presumably an attempt to capture the breadth, depth, and complexity of change that needs to occur. No quick fix this time. more…