Briefing from Robert Francis QC

A collection of tweets with key messages from the briefing with Robert Francis QC at Templeton Hotel, Templepatrick on Wednesday 24 April.

  1. Gerry Guckian, Chair of Southern HSC Trust and Chair of NICON opened the meeting.
  2. Now, we in NI get to hear fro Robert Francis QC directly.
  3. A great opener.  Robert Francis tells us how he read Florence Nightingale's writings as part of his preparation for the inquiry.
  4. #niconfrancis RF begins with Florence nightingale - first do the patient no harm!
  5. Robert Francis - Florence Nightingale said 150 years ago that first principle of hospitals is they should do no harm #niconfrancis
  6. Robert Francis told us about the 'Cure the NHS' group and the personal cost to its members of speaking out.
  7. We must listen to difficult people - they often speak at great cost to themselves #niconfrancis
  8. Francis reminds us that we must acknowledge our shortcomings in order to fix them.
  9. Francis reminds us that we need to listen to those who complain more than those with good things to say. #niconfrancis
  10. Heather Moorhead, Director of NICON hits the nail on the head here....
  11. 1m pages - 250 witnesses -cost £13m - only worth it if there are changes #niconfrancis.
  12. Robert Francis put up a slide showing a picture of Mid Staffs and pointed out the location of the CEO's office - right at the back corner of the building, far from the front door and clinical areas.  He also pointed out the union office - a caravan in the carpark near the front entrance.  I wonder did this prompt our local CEOs to reflect on the location of their own offices?
  13. #niconfrancis The remoteness of senior managers offices in Mid Staffs reflected the disconnect with care
  14. Francis points out remote location of CEOs office at Mid Staffs. Remote from clinical areas and front door. #niconfrancis
  15. Francis points on the many early warning signs that all was not well at Mid Staffs.
  16. Stories like this are hard to comprehend...
  17. Levette lamb of the HSC Safety Forum and Heather Moorhead sum up the stories we heard - 'harrowing' and 'heart breaking'.
  18. #niconfrancis harrowing stories from Francis on poor care and lack of dignity
  19. Heart breaking stories - naked patients and people left to wet the bed #niconfrancis
  20. This excerpt from an internal Trust Inquiry into an SUI was shocking in that it identified the propensity for this to happen again.  But what was done to fix it?
  21. Striking suggestion that something as low-tech and inexpensive as a relatives group could have prevented what expensive civil servants, regulators, commissioners, managers, clinicians, and targets could not.
  22. @DrStevenKinnear @Levette22 struck by Robert Francis comment, had there been a relatives group #MidStaffs would likely have never happened.
  23. Quotes such as the one below hit the audience like a sledgehammer - making us realise just how awful things must have got at Mid Staffs.
  24. One dr said - u either become immune to the sound of pain or u walk away!!! #niconfrancis
  25. The pressure to meet targets finally pushed the staff to compromise their integrity..
  26. CULTURE comes up again!
  27. Francis tells the story of an Emergency Medicine Registrar who rotated to Mid Staffs and could see the problems, but when he raised them appropriately nobody listened.  Are trainees' views and contributions undervalued more widely in the health service?
  28. Listening to Francis tell stories like this reminded me of the theory of 'learned helplessness' I was taught at medical school.

    Do we all have a limit to our energy, enthusiasm and motivation to improve difficult circumstances, after which we can be broken down and become disempowered, helpless, disengaged and desensitised?
  29. Francis implores us to make changes now.  The most powerful recommendations in his report require no government policy or legislation to implement.
  30. Don't wait for new policies and guidelines in response to Mid Staffs, act now, put patients first #niconfrancis  http://sdrv.ms/11BX8K2 
  31. Francis tells us that trainees are the eyes and ears of the system.  They are intelligent, motivated people right there at the front line.  They also have the benefit of rotating through Trusts so they don't get infused with any one culture.  Therefore, they can feel and taste the difference in cultures between organisation and can spot a bad one.  They can also see what works, what doesn't work and what can be done to improve.
  32. Trainees are the eyes and ears of the hospital and agents for safety, quality & learning. #niconfrancis  http://sdrv.ms/11OMFIA 
  33. Trainees are the eyes and ears of the system - how are we using them to improve safety and quality? #niconfrancis
  34. Francis highlights some of his recommendations related to nursing.
  35. Joan Harbinson asks an important question.  Many people are reluctant to 'complain'.  There is still a stigma to being a 'complainant'.
  36. Joan harbinson how do we overcome people's fear of complaining #niconfrancis
  37. Robert Francis picks up on this by pointing out that the word 'complaint' is not helpful.  How could we change the language?
  38. Healthcare is THE people business.  People helping and caring for other people when they are ill and vulnerable.  It is therefore essential to consider the staff.
  39. Meeting discusses need for partnership working with staff #niconfrancis
  40. In my career so far (and it hasn't been that long) I have read numerous reports, some a decade old, and then looked around me to see nothing has changed.  I think it's an important question therefore, how will the Francis Inquiry Report translate into changed practice and changed culture?
  41. Dr Kinnear asks - what is different about this report after many other reports #niconfrancis
  42. Robert Francis replied that the harrowing stories of human suffering made this report different by showing the human side of failings in healthcare.  He also hopes a continual review process will be set up to ensure changes occur.
  43. Robert Francis QC hopes his report will provide continual review process in #NHS #niconfrancis
  44. This is a common theme recently - is the service designed to suit those delivering it rather than those receiving it?
  45. Mary mcmahon asks - Does the interest of the service top the interest of the patient? #niconfrancis
  46. I think this statement from Robert Francis send some culpability right up the chain to politicians and officials who set targets and then dogmatically insist on them being met.
  47. Give a manager a target and that's what he'll achieve - hitting the target but missing the point. #niconfrancis
  48. I personally believe that staff are the best source of finding solutions to problems.  It has certainly been my experience as a Medical Manager that were a problem seems intractable - ask the staff and they will give you numerous suggestions and often ingenious solutions you couldn't have dreamt of yourself.  My job is often facilitator, case-for-change maker, engager, empowerer, and hurdle removal officer.
  49. Robert Francis QC #NHS healthcare professionals in mid staffs felt disengaged because they were disempowered #niconfrancis
  50. RF - you need much more independently minded people - a culture of meeting targets alone does not work #niconfrancis
  51. The government proposal to have all nurses work as HCAs first has been controversial and Robert Francis pointed out that it wasn't suggested by anyone who gave evidence to the Inquiry.
  52. #niconfrancis @bobjbrown asks Francis to comment on the proposal to have nurses work as HCAs before undergraduate education
  53. @bobjbrown asks Francis about govt proposal re:prospective nurses being HCA first."Not suggested by anyone who gave evidence." #niconfrancis
  54. Robert Francis points out that commissioners must monitor what they get for their money from providers.
  55. Hugh McCaughey, CEO, South Eastern HSC Trust followed Robert Francis and talked about the NI Quality and Safety Journey and the SQE strategy at SE Trust.
  56. Hugh McCaughey, told us of the scale of the opportunity to improve safety with this shocking estimate of the number of avoidable deaths in the NHS each year.
  57. 20k-30k avoidable deaths in the Nhs each year - we need to pay attention to safety!!!! #niconfrancis
  58. @HughMcCaughey - Up to 30,000 avoidable deaths in NHS every year - what are we doing about it?
  59. Hugh McCaughey recommends raising the profile of safety work.
  60. It was reassuring to hear that NI mortality rate benchmarks well.
  61. Hugh McCaughy: NI mortality rate in #HSC benchmarks well compared to elsewhere in UK but debate driven by individual failings #niconfrancis
  62. This was my favourite slide from the event - 'The Great Conundrum' posed by Hugh McCaughey.  A very powerful slide.
  63. Hugh suggested a complaint of the month - but the story should not be about the complaint, but about how it was addressed and what was changed or improved as a result.
  64. Hugh McCaughy: Should be celebrating 'complaints of the month' in #HSC that are acted on #niconfrancis
  65. Complaint of the month - great idea to celebrate the difference people can make by contributing their experience #niconfrancis
  66. The following tweet by Hugh McCaughey made me think of Dr Mark Newbold, CEO at Heart of England FT who publishes a weekly diary openly demonstrating what he spends his time doing.  Could we see NI healthcare leaders doing the same?
  67. Hugh tells us how organisations with a culture of incident reporting tend to have better mortality rates.
  68. Another important slide from Hugh McCaughey - CULTURE again.
  69. Hugh highlighted important improvement work related to sever sepsis management in EDs.
  70. @HughMcCaughey highlights the excellent work of the NI ED collaborative on Severe Sepsis
  71. This idea of focusing on outcomes instead of top down targets merits much further thought.
  72. Hugh McC talks about outcomes - a new conversations than focus on top down targets #niconfrancis
  73. It's always interesting when managers talk about greater interaction with patients and service users.  Is there something Freudian in that? Because I and other clinicians interact with patients and service users all the time!  Maybe more managers need to spend more time where the business of healthcare is happening instead of in offices, board rooms and meetings?
  74. Hugh McCaughey highlights importance of interaction with #HSC users #niconfrancis
  75. Mary Hinds point out that commissioners and providers will need to work together to improve health services.
  76. Mary Hinds comments disengagement comm and providers - the solution will collective #niconfrancis
  77. Good idea below - let's get on the front foot and be proactive - not reactive.  I think TYC is already our proactive stance.
  78. @HughMcCaughey rec's the NI response to #Francis should be to manage our context - get on the front foot, engage and educate, #SQE culture.
  79. As I said above - healthcare is THE people business. and unhappy, disempoewered, disengaged people don't deliver good care to other people.  If you don't believe me read Robert Francis QCs Inquiry Report into the failing of care at Mid Staffs!
  80. Staff satisfaction is an important barometer of health in healthcare organisations #niconfrancis
  81. Gavin Lavery, Clinical Director of the HSC Safety Forum makes an interesting suggestion about how to measure staff satisfaction, engagement and culture.
  82. @lavery_gg suggests rates of staff suggestions for improvement and incident reporting as proxy measures of culture #niconfrancis
  83. Brilliant point!  The room was predominantly full of managers.  What about the people delivering care?  That's why I have collaborated with Adam Dalby and the Queens' Healthcare Leadership Forum to deliver a Francis Briefing and discussion for students and clinical staff -  http://qhlffrancis.eventbrite.co.uk/ 
  84. Hugh McCaughey agrees with Francis about the importance of trainees but also includes nursing and AHP students in the mix.
  85. @HughMcCaughey highlights that junior docs, nursing students and AHP students are key people to listen to abt your culture #niconfrancis