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The Francis Inquiry Demands Strong Leadership Not Damage Limitation

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ROBERT FRANCIS QC
PA

The long awaited Francis report into NHS standards of care has been published (6 February 2013) and it's every bit as stark and challenging as we had imagined. It is a heartrending read. The thoughts of all of us in the NHS are with the friends and families of those affected by the failings at Mid Staffordshire, who now have to re-live the experience. I do hope the report will bring them some comfort about the changes the report will undoubtedly herald and they will feel some sense of justice. It's seems right to me that we should welcome the journalists analysing and commenting on the potential implications. It is an important part of any inquiry. But as leaders in the NHS we also have to help with the sense making process

As a human resources professional working in the NHS you get to see the very best in people, the very best in our staff. Day in and day out in our hospitals, in our community services, in our GP practices and our mental health services. Outside of our organisations, you only have to watch reality TV programmes set in accident and emergency departments or maternity wards to see examples of unfailing compassion, bravery and the exercise of incredible skill, knowledge and expertise. Saving lives and bringing hope to people where care and compassion are what matter most. It makes me incredibly proud of the NHS and of its staff and the environment that makes this common place.

These innumerable acts of kindness, empathy and healing don't make the news headlines or generate inquiries but it is right that, even in the midst of making sense about Stafford Hospital, we acknowledge and recognise this element of our NHS and the staff that make it happen.

In HR you are also exposed to the situations where it goes wrong, whether through staff conduct, capability issues or sometimes though having insufficient resources at the right time. In the NHS this is always traumatic, always painful and can sometimes affect your belief in the generosity of the human condition.

How can these things happen? Where did it go wrong? Could we have intervened earlier? Mid Staffordshire highlights this in a stark and very public way. We will see those emotions play out as we all question and challenge ourselves

The report contains some recommendations that will certainly impact on the way we work, manage and lead our organisations. Away from the headlines about the role of regulators and national organisations, what we are left with is recommendations at the heart of our people management practices.

NHS organisations, and I'm sure those in the care sectors too, will be reviewing recruitment and selection processes, induction, appraisal, supervision and management, benchmarking staffing levels, reward, and recognition as well as policies and approaches to support staff health and wellbeing, how staff raise concerns and how they are responded to. These are key components that shape our organisational culture and provide an opportunity to test out and check whether our actions support or detract from our core organisational values. Do these management practices build respect, compassion, care and make sure everyone feels valued. This is a core leadership function and we have to ensure we get it right by grasping the opportunity now.

But a key question remains. Will the NHS come though this stronger or considerably weaker and more vulnerable than it was? If the latter is true it will have far reaching consequences for patient care for years to come.

Our leadership challenge now is to show quickly that we have the ability to take the Francis report and make sure the NHS, the services it provides and the trust the British public have in it increases and enhances its reputation as one of the world's leading health care systems. To take an approach of damage limitation, hunker down and hope we come though will be insufficient and wrong minded. The goal must be one of improvement.

Research by Professor Veronica Hope-Hailey, of the University of Bath School of Management, shows that those organisations that have 'trust credit' can come through crises stronger. The NHS has built up, over its 65 years, considerable credit and trust from our citizens. The results from a recent Ipsos Mori poll show that more people named the NHS as something that makes them proud to be British than the armed forces and Team GB. This is impressive. We cannot afford to let this slip. We all need an NHS that is well loved and respected and that is safely and efficiently managed. It's our job to deliver both.

The Francis report will mean we all take a long hard look at our approach, our leadership and the culture that allowed Mid Staffordshire to happen. This has to be far more than a collective cathartic process. Over the next few months our actions will be far more important than our words. It will involve teamwork and cross organisational leadership. It will require us to focus on zero harm and that means not disregarding occasional and sometimes tragic poor care just because there is so much more that is good. But there are other challenges too. The public inquiry, as important as it is and with its major focus on safety and compassion, doesn't address all the issues we as leaders need to focus on. We know there are other unnecessary but seemingly hidden deaths. We will need to shout loud to ensure we get across the importance of issues like:

- the public health challenges of alcohol and obesity
- health inequalities and the shocking disparity in life expectancy between regions
- the discrimination still suffered by some on the grounds of race, gender or sexual orientation

If we can marshal our spirits and do this, then we respond to Francis and the recommendations effectively - led by our common values and common purpose. And perhaps, in the next generation, Francis can become a byword for improvement rather than failure.

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