Driving quality implementation in the context of the Francis report

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| | Foreword Endless changes to the National Health Service (NHS) have been characterised by a top-down, managerial approach. As David Prior, Chair of the Care Quality Commission (CQC) observed recently, clinicians have in part ‘allowed the false dichotomy of clinical leadership versus “management” to emerge’ and to go unchallenged. They have become disengaged from a culture characterised by obsession with financial targets and systems whose purpose has been self-perpetuation of the organisation (Prior, 2013), while patients have – in some cases literally – faded away. Clinicians risk drifting into an insidious mindset of learned helplessness; when they speak out, their voice has at times been frail and even inaudible. As clinicians we need to listen to and learn from each other, and listen to and learn from our patients and their carers. We need to help the organisations in which we work to take more seriously what has so rightly been called the ‘gold dust’ of complaints (The Independent, 2013). We must take complaints more seriously and challenge riskaverse cultures. Above all, within the Royal College of Psychiatrists we need to appropriately support whistle-blowers and other members whose working circumstances and the expectations placed on them are incompatible with delivering safe practice. Clinical leadership, transparency and accountability are fundamental to the future of the NHS and all health and social care. Never before has there been a stronger need for the family of medical Royal Colleges to stand together to work on the fundamental commonalities of tackling unacceptable variability both in practice and in clinical outcomes, across geographies, 7 days a week. The Academy of Medical Royal Colleges is 220 000 doctors strong; our own College is 17 000 strong. Both need a unified voice to tackle the variation within and across services throughout the UK. The College response to the Francis report therefore stands alongside and links with the response of other medical Royal Colleges, allied health professional bodies, providers, regulators, commissioners and educationalists. It has evolved from ongoing discussion with and feedback from College Council, honorary officers, faculties, sections, divisions, the four UK jurisdictions, members, patients, carers, special interest groups, College leads and special committees. This is therefore a dynamic document, which the College will revisit in 6 months’ time. It provides an ethical framework against which we will align and test College strategy and activities. 2 Occasional Paper OP92
Much work has already been undertaken to mitigate the realities of the worst care seen in Mid Staffordshire NHS Foundation Trust and Winterbourne View hospital. Complacency, and seeing challenges as ‘not my business’, have been, and will continue to be, the enemy of good, safe, whole-person patient care. Continuously reviewing what works, testing out, revisiting and refining, are essential for providing values-based, whole-patient care. Most importantly, robust and continuous review of our own individual clinical and academic practice in diverse teams, organisations and settings has to be underpinned by intelligent kindness. My sincere thanks to the many College members and other colleagues who have responded with the wise thoughts and practical suggestions that have contributed to this response to the Francis report. Professor Sue Bailey, OBE, FRCPsych President Foreword 3
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Page 3: | | Contents 2 Foreword 4 Introduct
Page 7 and 8: and a variety of behavioural cues.
Page 9 and 10: Faculty of Public Health, to which
Page 11 and 12: | | Principle one: always put patie
Page 13 and 14: active in all discussions about the
Page 15 and 16: College actions The College is work
Page 17 and 18: | | Principle three: provide high-q
Page 19 and 20: | | Principle four: respect regulat
Page 21 and 22: and are optimised in the treatment
Page 23 and 24: College actions 1 The College suppo

Driving quality implementation in the context of the Francis report

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