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The recently published Francis Report into the standards of care at Mid Staffordshire NHS Foundation Trust did not make comfortable reading, and sadly it brought few surprises.
The recently published Francis Report, which provided a deep and insightful analysis of the multitude of interviews and investigations undertaken during the inquiry, could leave no doubt as to the scale of the problem in Stafford. My first thought was one of respect for Robert Francis QC, for his highly insightful report; my second was one of discomfort – discomfort at the way an independent individual had pulled aside the curtains of mystery that still surround anything medical and exposed some ugly truths. My third reaction (and I’m sure I’m not the only biomedical scientist to have felt this) was a feeling of relief that pathology was not specifically mentioned. Perhaps that seems a somewhat inappropriate thing to say, but anything less than totally honest in this instance would be even more inappropriate.
It is very easy to breathe a sigh of relief when the spotlight falls on other people, other professions, and then feel satisfied that our house is in order, but that’s not good enough. It simply perpetuates the ‘blind eye’ culture that goes hand in hand with systemic failings. I seriously doubt there was a disproportionately high number of uncaring people working for Mid Staffordshire NHS Foundation Trust, and rather suspect there was a workforce that became sucked in to a culture where the priorities, and associated pressures, had shifted so that the welfare of patients had become secondary to the welfare of the balance sheet.
Herein rests the challenge to us all. We know we cannot return to a situation in which spending simply increases year on year, but we also cannot accept a mindset where the importance of the balance sheet is greater than that of the bed sheet. So, where does that leave us in pathology? It is obvious to me that patient care is at the heart of our profession, even though the pathology workforce and service is largely unknown to many patients. Our role is not one that is bathed in the spotlight, despite it being one on which every patient relies at some time in their life. So, what can we do to play our part to ensure there is not a ‘next time’? We take part of the collective responsibility for patient care; we maintain and uphold our standards of quality, training and science. I genuinely think that comes to us as second nature, but there is a bigger challenge: culture change.
A culture of blame and bullying is one that erodes the very essence of professionalism, causing individuals to abandon their principles and develop a Pavlovian response of covering their back in the face of threats and accusations of inefficiency. This culture was not unique to Mid Staffordsire NHS Foundation Trust, even though it was particularly prevalent and damaging. The blame game is something for which we appear to have developed a national fondness, and it is accompanied by the equally unpleasant flip side, self-righteousness.
In healthcare, a corporate culture cannot be allowed to be at odds with a caring culture; they are not mutually exclusive, and without that balance of relationship there will not be meaningful progress towards a health service that is both economically and socially sound. Here is the part we play; we examine our social responsibility to our patients and ensure it goes hand in hand with our professional responsibility. If every person in every healthcare environment did that in some small way, together we might bring about that change.
Deputy Chief Executive