What the Francis report means for mental healthcare

13 March 2013

Originally posted in the HSJ blog Leadership in Mental Health, 6 February, 2013

The Francis report today set out some 290 recommendations to protect NHS patients from neglect and poor care. The report’s recommendations reach across the health services, from the accountability of individual professionals for their own conduct to the roles of the national regulators, professional organisations and the Department of Health.

 ‘The report raises questions about the relationship between personal and corporate accountability’

Like all parts of the NHS, the report will have a major impact on mental health care. It will change the way mental health professionals and organisations work, as well as affecting the wider systems and processes in the NHS within which mental health services operate.

The report’s publication comes just weeks after the publication of the government’s report on the abuse of patients at Winterbourne View and the system failings that surrounded it.

Last week, the Care Quality Commission’s annual report on the use of the Mental Health Act reminded us that a significant minority of people who are detained in hospital compulsorily are not given the quality of care and support that we would expect to receive or indeed that the act requires.

New duties

Taken together, all three reports suggest while there has been genuine progress towards giving service users a bigger voice in their own care, in treating people with dignity and respect when they are in hospital, and in responding positively when things go wrong, we have a long way to go.

Too many people’s experiences of being in hospital are of losing power and control, of feeling bewildered and “done to”, and of not knowing what is happening to them. For detained patients, these painful experiences can be magnified many times without the active support of families, friends and advocates.

For mental health professionals, managers and leaders, the Francis report’s recommendations will create new duties and forms of accountability. Professionals and organisations will have higher expectations in the way they conduct themselves and tougher sanctions, including proposed new criminal offences, when things go wrong.

This will, and should, provoke debate about the balance between professionalism and regulation in the maintenance (and improvement) of standards in healthcare. It raises questions about the relationship between personal and corporate accountability when care falls below the proposed “fundamental standards”.

Consequences for all

These are not new issues, but with decision making in the NHS increasingly devolved to local organisations it is vital that everyone in the system is clear about where accountability lies and what to do when they are concerned about quality of care. As Robert Francis’ report acknowledges, any new system must have the support of the health professions and be clearly understood by patients and families.

The implications of the report are no more nor less applicable to mental health services as to other parts of the NHS. However, we will need to examine closely how any new arrangements intersect with those in place in social care, for adults and children alike.

‘A considered response to Francis should include a full assessment of what it will entail for mental health services’

Unless quality regulation and accountability are well aligned between the two systems, service users and their families will be left to negotiate a difficult path between them both. Mental health care extends well beyond NHS facilities to private and voluntary sector providers, prisons and police stations. Again, it must be clear how standards will be applied: how, for example, might any new system help to prevent more deaths of vulnerable people in custody?

The Francis report demands a considered and timely response. Service users, families and professionals need to know what it will mean for them. That considered response should include a full assessment of what any actions will entail for mental health services and their partners, inside and outside the NHS. How, for instance, can we ensure that the proposed new standards and the “duty of candour” will help to protect detained patients and those on community treatment orders?

The NHS has a lot of reflecting to do. It must balance decisive action with the avoidance of knee-jerk responses to a report with profound consequences for all of us. A mature response − with a clear sense of what it means for people with mental health conditions, their families and those who support them.



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