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The lessons councils must learn from the Francis report

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The recent Francis Report heavily criticised the health service but what about local government’s role?

The report into the tragic events that took place Mid Staffordshire NHS Foundation Trust was published on Wednesday this week (6 February 2013). Robert Francis QC had been charged with examining why the elaborate system of checks and balances within the NHS system and beyond failed to identify at an early stage what was going wrong with patient care at the trust.

His damning conclusion – that the failings went right to the top of the health service – and his key recommendations to address this, including a new statutory duty of candour for doctors and nurses and a new criminal offence of failing to adhere to basic standards of care leading to death or serious injury, have been widely reported. What has attracted much less attention is what the report said about the role of local government in the sorry story and the recommendations for changes in how that role is carried out.

Both Stafford BC and Staffordshire CC had a scrutiny and oversight role in relation to the main trust hospital, exercised through Overview and Scrutiny Committees (OSCs). The relevant legislation and guidance make it clear that OSCs have an important role to play in looking at safety and quality issues affecting their community.

Robert Francis’ conclusion was neither OSC had properly fulfilled that role and he was particularly damning of Staffordshire CC’s OSC. “This committee appears to have been wholly ineffective as a scrutineer of the Trust. councillors are not and cannot be expected to be experts in healthcare. They can, however, be expected to make themselves aware of, and pursue, the concerns of the public who have elected them. That is surely the purpose of giving a local scrutiny role to councillors,” the report said.

The report made two specific recommendations in respect of OSCs –

  • That they should have “appropriate support”, so as to allow them to be effective, including easily accessible guidance and benchmarks
  • That they should have powers to inspect healthcare providers, rather than relying on local patient involvement structures to do this, or should actively work with those structures to trigger and follow up inspections.

The government is going to respond in detail to all of the recommendations in March. In relation to OSCs there are clear resourcing issues to be considered and some creative thought may be needed on just how “appropriate support” can be provided in a cost effective and efficient way. The suggested power of inspection is wholly new and careful thought will need to be given as to how, if it is introduced, it can best be used.

Pending any formal changes in position, one thing that OSCs need to consider now in light of the Francis report is whether they are successfully capturing patients’ and the broader public’s views on the healthcare organisations that they scrutinise and then how those views are used to inform their activities. A theme running throughout the report is the failure of pretty much every institution involved to do this and it is something that OSCs, along with everyone else, needs to think hard about now.

Adam Chapman, partner, Kingsley Napley LLP

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The lessons councils must learn from the Francis report

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Readers' comments (1)

  • I think the lessons of Francis are wider than this for local government. Culture was a big aspect of the review and we need to be mindful of the top down rhetoric from DCLG, DfE, DH. Budgets are being cut more severely in local government than in health, of which adult and children's social care is now a major component. We need to be very mindful that our behaviours do not lead to the same tragic consequences as at mid-Staffs.

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