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Dr Patrick Cadigan on the Francis Report and RCP involvement

During our St Luke's Symposium, our Medicine in Changing Times event on Saturday 19 October features a session on the Francis Report and its implications for patient care. Among those speaking are Dr Patrick Cadigan, Registrar of the Royal College of Physicians (London). We spoke to Dr Cadigan about the Francis Inquiry and the Royal College of Physicians’ involvement.

In the UK in February this year, the Francis Report told a story of appalling suffering of many patients within a culture of secrecy and defensiveness. The Inquiry Chairman, Robert Francis found that while many staff did their best in difficult circumstances, others showed a disturbing lack of compassion towards their patients. Staff who spoke out felt ignored and there was strong evidence that many were deterred from doing so through fear and bullying. 

Can you tell us about the RCP’s involvement in the Francis Inquiry?

The RCP was a “core participant” in the second Francis Inquiry, which reported in February of this year. This meant that we had to give both oral and written evidence in the form of opening and closing statements and that we were allowed to suggest lines of inquiry that the Francis legal team might pursue when questioning other witnesses. We were the only Medical Royal College to be designated in this way.

In this role we were also invited to attend the seminars that Francis arranged to discuss key areas of his report, such as regulation, leadership, organisational culture, patient experience and nursing.

Additionally, our Vice President for Education and Training, Professor David Black, was, in a personal capacity, one of Francis’ key advisers.

Our initial response to the problems experienced by patients in Mid-Staffs hospital began in 2010 with the publication of the first Francis report, which gave details of the shocking lapses in care. The College launched several work streams aimed at improving and assuring the quality of care and it was gratifying to see that Francis made direct reference to these in his report.

What were the main themes that emerged in doctors’ evidence at the Inquiry?

Oral evidence to the inquiry from RCP members raised several important areas which we were able to discuss with Francis and his team.

The first point was that there needs to be absolutely clear lines of accountability and responsibility for patient care. In the UK the 1983 Medical Act holds the consultant, as the senior medical professional on a ward, legally responsible. But it is clear that, with the onset of team working and with changing relationships with other health professionals, these lines of authority can be blurred. We asked Francis to explore this in the context of professionalism, professional leadership and professional accountability.

The second theme that emerged was that of “whistle blowing” and in particular the reporting of patient safety concerns outside the employing hospital. The College was disappointed that the Physicians at Mid- Staffs had not approached us for support but noted that our ability to do this had been restricted by the abolition of statutory College visits to hospitals. We submitted evidence to Francis on the possible role of professional networks in providing a safe haven for whistleblowers and have piloted a scheme in which the College acts as an agency in feeding back anonymised comments to management.

Finally we were able to support the view that there needed to be a major focus on the poor quality of care “out of hours” with much more consistent consultant input.

Were there any recommendations in the Francis Report that you/RCP were particularly keen to see included?

We were pleased to note that Francis picked up on many of the themes that we had identified as important. I think one of his most important recommendations, in terms of the doctor of the future and our training programmes, is that training should only take place in environments where there is high quality care. Francis also noted that trainees were the “eyes and ears of the system” and should be used as a source of information by regulators.

From a doctor’s perspective, what are the key lessons to be learned from what happened in Mid Stafford Foundation Trust hospital?

That the events at Mid-Staffs were not unique to that environment and that it is a shared responsibility, and a critical role for professional leadership, to take ownership of policies and behaviors that will guard against similar lapses of care in our own hospitals.

Has the Francis Report changed RCP’s approach to patient safety and quality improvement?

The RCP has reviewed all its training, education, quality improvement and patient safety work and tested it against its ability to meet Francis’ objectives. The result of this analysis and the resulting program of work are contained in the “Putting patients first” document published on our website on 3 September 2013.

Hear more from Dr Patrick Cadigan at Medicine in Changing Times in RCPI on Saturday 19 October 2013 

Book your place at this year's St Luke's Symposium online now.