Salt and Light after the Francis Report: What Does it Mean for Christian Nurses?

The horror stories that emerged from the evidence gathered in the series of enquiries into the failure of care at Mid Staffordshire NHS Trust have shaken the long held national belief and trust in the NHS. Horror stories of patients left in soiled bedclothes because nurses were too busy to take them to the toilet, people being triaged by A&E receptionists, others being left unable to reach food or drink and literally dehydrating and starving to death.  The catalogue of neglect makes for horrific reading.  Hundreds, if not thousands of patients, are thought to have died and suffered unnecessarily as a result of poor care at just one hospital.  At the time of writing, thirteen more NHS Trusts are under investigation after patients and staff raised
concerns about care standard.

The second Francis Report published in February sought to address the reasons for wider, systemic failure to police the care standards at Mid Staffs and across the NHS.  The Trust management are castigated for a blind focus on targets and cost savings at the expense of frontline staffing and quality of patient care. The professional bodies (most notably the Royal College of Nursing) are attacked for a failure to
support or take seriously whistle-blowers.  Other regulatory bodies, professional bodies, educational institutions, the NHS Executive and the Department of Health all come in for criticism.

Francis makes 290 recommendations – it is not a short or easy read, even for a public inquiry, which means, sadly, that few if any of them will ever be taken up.  Central to his recommendations is that transparency becomes a legal duty for NHS trusts and professional bodies – a ‘duty of candour’ should be legally enforced on all NHS staff, requiring honesty about mistakes.  Furthermore, gagging orders to stop disclosure of ‘unpleasant’ stories in the media should be made illegal, and professional bodies must be more
proactive in supporting whistle blowers reporting on failures of care.

The other central theme is that there needs to be an overall culture change in the NHS that puts patients and their needs at the centre of the system. This seems so fundamental that the inquiry’s need to state it explicitly and in detail suggests how far NHS structures and institutions have drifted away from their original purpose.
Significantly, while good leadership is vital to this, Francis makes it clear that the culture change is the responsibility of every NHS employee, from ‘porters and cleaners to the Secretary of State’.  It is a bottom up change, not further top down restructuring that the inquiry advocates.

Sadly, the government’s response seems to have missed the boat on this last theme, focusing instead on the exact opposite – more top down regulation with yet more new sets of quality targets, a new inspectorate for hospitals, and a proposal that nursing students be required to spend a year before training working as care assistants.  Legal measures to stop NHS managers responsible for failing trusts being re-employed in the health service and a legal duty of candour on health professionals and institutions finish off the main responses from government.

It is hard to be in nursing in the UK at the moment, as it seems everyone is blaming us for the systemic failure of the health service.  But it cannot be laid at the door of a single profession or single set of values or government policies.  It is institutional sin at its worst – a culture within institutions and professions that promotes the needs of the providers over the needs of patients.

Paul reminds us that ‘our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms’ (Ephesians 6:12).  There is a spiritual side to this – something of the enemy that blinds even the best of us to the truth at times.  So first and foremost we need to pray – for our professions, our workplaces, our managers, and our political leaders.

But most of us go into nursing because we are compassionate people. As Christians we also have the strong motivation to do as Jesus taught us – to do for the least of those in need what we would do for Jesus himself.  So we also have a prophetic responsibility to speak truth, to be whistle-blowers, to care in a different spirit when those around us seem to have lost compassion, and to encourage, commend and work alongside those who are caring to the highest and most compassionate standards (Isaiah 1:17, Psalm 82:2-4 and Proverbs 31:8-9).

We need to be salt and light in the NHS more than ever, and to win back trust from the public.  It will take prayer, it will take faithfulness and courage and it will take leadership. Above all, it will take time. This may seem impossible, but with God, nothing is impossible (Matthew 19:26).

What can you do? Start with prayer. Start everything with prayer.  If you can, find one or two others who will pray with you—and pray for others who will also join you to pray, who will act with integrity and courage and compassion.  Pray for your workplace, your colleagues, your leaders, your patients.  Let God transform your workplace one person, one prayer at a time.  Ask God to show you the way—at whatever level you work, from student to Charge Nurse, from Director of Nursing to Staff Nurse.  It doesn't matter that you feel you cannot make a difference—God can, and he uses those who doubt their own influence and voice to speak, if they will just trust him to speak.

And, above all, do not despair, but trust God and seek to honour him wherever you work.  This is a golden moment for God to work in our health system.

Steve Fouch