Quality of care is an issue we all need to face up to
In the latest state of health and social care report from the Care Quality Commission (CQC), for example, 10% of NHS hospitals inspected "struggled to make the respect and dignity of patients their number one priority". The most commons areas of failure cited were lack of privacy, call bells out of reach and staff speaking to patients in a condescending way.
Alongside these issues is the deeply disturbing evidence that, in parts of a very small number of trusts, the quality of care has dropped to very low levels indeed for a prolonged period: large numbers of patients are potentially dying unnecessarily. The demonstrable lack of adequate care in parts of Mid Staffordshire NHS foundation trust between 2005 and 2009 is an example.
This was a clear failure of leadership and governance, of management and individual staff, although a new leadership team has since brought about significant improvement. It is important to highlight that all the evidence suggests that incidents of this magnitude and widespread patient impact are rare and isolated.
The evidence is also clear in the commission's report that issues of poor care can occur any type of trust. This is not a high or low performing trust issue; nor is it driven by type of trust, size or specialism. Acute, ambulance, community and mental health trusts all face the same kind of issues. Issues with care quality are not confined to secondary care, either; they occur in primary care as well.
They are also not uniformly distributed within each trust: "Often [CQC] … inspectors saw significant differences within the same hospital – where one ward got it right, another in the same building was getting it wrong".
There isn't a single, universal, cause, and a wide range of different influences are at play. These include granular factors like quality of leadership, staffing and resource levels, training and how individual staff members discharge their responsibilities.
They also include system-level issues such as societal attitudes to ageing and the effectiveness of regulation. The overwhelming conclusion is that more evidence is needed to understand fully why poor care occurs.
As a sector, we should acknowledge that instances of poor practice exist and we now need to own, understand and tackle this problem together. Acknowledging the problem shows we will take responsibility for solving it. It also gives confidence to patients and staff that we won't try to pretend it doesn't exist.
Boards have a duty to account for their own performance and their trust's performance. So, notwithstanding the role and impact of other system players, ultimate responsibility must rest with the trust board.
The NHS also needs to improve how it listens to patients and families. Enhanced transparency and publicly available performance data, including aggregate assessments, will help, even if this information may be uncomfortable at times for trust boards.
If there is a problem with care quality, we need to acknowledge that trust boards have not been universally successful in delivering the outcomes expected by patients and the public.
Delivering quality care is a shared endeavour between five partners: NHS trusts, regulators, commissioners, staff, and patients. Following the Francis report, we will need to act in all these areas. But, as David Behan, the commission's chief executive, has argued, we need to avoid over-emphasising any one of them at the expense of the others.
While we need to acknowledge that we have an issue with pockets of poor care, we can take heart from the NHS's ability to meet changing demands and new challenges.
We have made major improvements in reducing hospital acquired infections, cutting ambulance waiting times, phasing out single-sex wards and extending service user involvement in mental health. Now we need to tackle poor quality care wherever it occurs.