What will the Francis report mean for social care?

The report about the scandal at Mid Staffordshire NHS trust will have a far-reaching impact on the social care sector

The long-awaited Francis report will be published on Wednesday – nearly four years after a Healthcare Commission report exposed how patients, families and the public had been failed by the very institution set up to care for them: the NHS.

Since 2009, much has been written and said about what went wrong at Mid Staffordshire hospital, why it went wrong and what should be done to prevent it ever going wrong again. Along with the snow in January, we have had another blizzard of articles and comment with ministers and nearly everyone else second-guessing the conclusions and recommendations Francis will make.

Much of this commentary has concentrated on the NHS – Mid-Staffs was a local hospital after all – but I believe that the Francis report will have a far-reaching impact on the world of social care too.

The signs are that politicians will wish to cast the net beyond the NHS. In an article for the Sunday Telegraph, health secretary Jeremy Hunt reflected upon the changes needed in response to Mid Staffordshire, and commented:

    “Nor is it just a problem in hospitals, with equally shocking failings happening at certain care homes too.”

Last October, shadow care minister Liz Kendall, speaking at the Action on Elder Abuse safeguarding conference, predicted that “there are likely to be further changes in the way health and social care are regulated following the Francis review” (my emphasis). This is not surprising. While excellent services are provided in residential and domiciliary settings, tales of poor care, and a mandate for action from an independent inquiry, mean it would be foolhardy for any politician to ignore the opportunity to make a difference across the whole care and support system.

We are all rightly shocked when failures in care are exposed. Although we know some rogue individuals creep into our sector, more often these are system failures caused by deficient leadership, insufficient funding, faulty process, inadequate training or poor communications. Francis will, I am sure, be scathing of the NHS structures and systems that impacted on Mid Staffordshire – any reading of the inquiry transcripts can confirm that – but so many of these issues impact on social care too. We need to be ready for further debate about:

• System regulation – the overarching structure and responsibilities of regulators the Care Quality Commission and Monitor
• Workforce regulation – specifically for managers and care assistants

• Leadership responsibilities – especially the corporate responsibility of boards providing services
• Commissioning – concentrated on the role and accountability of commissioners in securing high quality care

• Integration – focusing on the needs of the individual by joining together the best that the social care and health system can offer
• Culture – openness and transparency will be the watchwords

Efforts to address these issues are increasingly taking a broad health and care system focus – for example Compassion in Practice, launched in December by the top two nurses in England, is explicitly a strategy for nurses, midwifery and care staff, not just those working in the NHS. Former care minister Paul Burstow has recently published a paper exploring how corporate bodies could be held criminally responsible for abuse and neglect that takes place in hospitals and care homes. And there are already some fantastic examples of good joined up working across the country and featured on our Social Care TV website.

It is unlikely that the response to Robert Francis’s recommendations will focus only on the NHS – but we need to make sure the voice of social care is strong, to ensure proposed solutions are relevant and useful for us.

But the most important reason is that this is all about people and the care and respect they deserve. The events at Mid Staffordshire remind us of the awful consequences when that focus is lost. Here again the influence of social care has to be strong. We must not fall into the trap of treating people who are using services as passive recipients of care, determining from on high the solutions we think will benefit them. We have a strong tradition in social care of working in partnership with service users, their families and carers, respecting their rights and valuing their voice. Whatever we do next, we must never forget that.