Francis Report: Some thoughts for Christian Nurses & Midwives

Today’s long-awaited publication of the second Francis Report into Mid-Staffordshire NHS Trust is being hailed by many as a watershed in the National Health Service.  Whereas the four previous inquiries into the failure at Mid-Staffs focussed on the specific failures of the hospital staff and management, this second report from Robert Francis QC focusses on why the many checks and balances in the NHS regulatory system so completely failed to pick on the problems.

The report highlights a massive managerial, cultural and organisational failure not just at the trust, but in commissioning bodies, professional bodies, training institutions, the NHS Executive and the Department of Health.  Somehow or other, every part of the system had a vested interest in ignoring or marginalising reports from staff who were raising concerns about the failures at Mid-Staffs. 

Of particular concern to nurses are the failures highlighted in the Royal College of Nursing in its role as both a professional body and a trade union.  It failed to support whistle blowers, and failed to take seriously the issues its own members were bringing to its attention.

As Christians we are obviously concerned to show the love and compassion of God to our patients – it’s why we went into nursing. But as a report on the BBC Radio 4 Today Programme this morning highlighted, so many nurses and midwives across the NHS even now struggle with staff shortages, target culture and pointless bureaucracy which constantly put pressure on them to spend less time and energy actually caring for their patients’ needs.  One midwife sadly said that while she loved being a midwife, her advice to anyone training today would be to seek as soon as possible to practice anywhere other than within the NHS or the UK!   All those speaking in this report wanted to remain anonymous and had their words spoken by actors – such is the climate of fear many feel in the NHS.  To speak out is to jeopardise your career.

This sounds very dispiriting, and I hear other stories regularly of very good care, and of nurses and midwives loving their work and working environment.  But so many also report their struggles with a system that tries to stop them caring.  Francis challenges this, proposing that openness and a culture of transparency are vital for the professions and institutions in the NHS. Speaking out for the poor and the vulnerable is a core calling for all God’s people, and we should be the first in line to speak out appropriately when things are wrong. 

The report also challenges all NHS staff to change the workplace culture away from protecting the institution and its priorities and towards caring for the patient and their needs.  It seems shocking that this needs to be said in this day and age, but the evidence of the report suggests that too often it is the protection of organisational interests that trumps care for our patients.  

Christians are called to show compassion to all who are in need, and to be salt and light wherever we find ourselves.  How can we be agents for change in our places of work? How do we each day model to our students, our colleagues, our managers and our juniors how to truly care? What values and priorities do we bring to the workplace each day, and how much do they rub off on those with whom we work?  It goes both ways, of course, so we need to be regularly filled with the Spirit and fed on the Word if we are going to come in a different spirit.  For that we need not only our churches to support and pray for us in our work – we need to seek each other out and support and pray for one another.

We will be waiting until March to hear what the government is going to do – how many of the Francis Report’s 290 recommendations it will actually put into practice waits to be seen.  But the report makes one thing clear – it will be bottom up change from ordinary staff that will truly revolutionise our health service, not more top down reforms. That is a challenge to us, to be the hands and feet of Jesus in the NHS and be his agents for change.