Driving quality implementation in the context of the Francis report

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prioritisation of listening to the lived experience of patients and carers has gained ever greater importance. RCPsych in Scotland Together with the Academy of Medical Royal Colleges and Faculties in Scotland, the RCPsych in Scotland is contributing to initiatives that will support the Francis recommendations. The College is a leading participant in the Scottish Patient Safety Programme for Mental Health; this was a major topic at its national academic meeting in September 2013. RCPsych Divisions in England The priority for the College’s Divisions in England is to support the development of high-quality practice through maintaining and developing standards. Each Division will: • z focus on providing high-quality educational events that maintain and develop mentors’ and trainees’ expertise in the areas of their continuous professional development (CPD) that cannot be met easily within their organisation and specialty z • further develop its recruitment initiatives to help ensure the provision of a high standard of consultant psychiatrists for future services. 8 Occasional Paper OP92
| | Principle one: always put patients first ‘It is a common complaint by patients and their carers that the various services are not “receptive” to our comments. It is the usual response of disbelief or just not accepting any comments especially if [they have] the mildest hint of criticism’ (member of the College Carers’ Forum). ‘We must put patients at the heart of everything that we do’ (Professor Sue Bailey, President). ‘Patients, their carers, their families and the public need good psychiatrists. Good psychiatrists make the care of their patients their first concern: they are competent; keep their knowledge up to date; are able and willing to use new research evidence to inform practice; establish and maintain good relationships with patients, carers, families and colleagues; are honest and trustworthy, and act with integrity. Good psychiatrists have good communication skills, respect for others and are sensitive to the views of their patients, carers and families. A good psychiatrist must be able to consider the ethical implications of treatment and clinical management regimes. The principles of fairness, respect, equality, dignity and autonomy are considered fundamental to good ethical psychiatric practice’ (Good Psychiatric Practice, Royal College of Psychiatrists, 2009). The Francis report highlights the need for patient-centred care and the consequences of failing to put patients first in a healthcare setting. Knowledge and skills are only one aspect of this; it takes the right attitude, culture and values to deliver true patient-centered care. Psychiatrists must be advocates for their patients, doing things ‘with’ rather than ‘to’ them, considering their individual circumstances and developing individual care plans within a framework of consistent evidence-based practice. Psychiatrists must work as a team with patients, carers and colleagues, and do this with compassion, dignity and respect. The NHS Constitution (Department of Health, 2013b) commits all NHS staff to: ‘be[ing] open with patients, their families, carers or representatives, including if anything goes wrong; welcoming and listening to feedback and addressing concerns promptly and in a spirit of co-operation’. This is alongside General Medical Council (GMC) Good Medical Practice (2013) which sets out the requirement for all doctors to: ‘listen to patients, take account of their views, and respond honestly to their questions [and] be open and honest with patients if things go wrong’. An important strand of patient-centred care is continuous and consistent focus, action and monitoring centred on the minimisation of harm and risk. In the context of mental health this can include minimising the risk of a patient harming themselves or others, and, unlike the rest of medicine, psychiatrists have an additional role and responsibility in that they are given the power to detain people under relevant mental health legislation. The comprehensive assessment of the patient must at all times involve the patient as fully as possible, weighing risk with input from all those who need to be involved, and putting in place a plan which respects individual autonomy as much as possible, with the understanding that therapeutic risk must be balanced against restrictions Principle one: always put patients first 9
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Driving quality implementation in the context of the Francis report

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