Driving quality implementation in the context of the Francis report

| | 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