Roy Lilley in brilliant form on the Francis Report:
Well, I've done it. With a bucket of builder's and a box of Hobnobs, I've ploughed through the Francis Inquiry Report.
I'm not sure I'm going to be too popular for saying this but I'm underwhelmed. True, it is a huge document, forensically written but as an epitaph to the dead and a tribute to the relatives it falls short. Hundreds have died and no one is to blame. Collective responsibility brings a welter of apologies but no real regret, no remorse and no repentance. Francis points a finger but makes no direct allegations. Francis admonishes without naming names.
Hours before the Francis report was published Number 10 had decided that its 290 recommendations were not enough. One more was needed. The Prime Minister announced he alone had the solution; an Inspector of Hospitals. If that is the solution I suspect Francis would have said so. Why didn't he? Because he knows what we know; it is bureaucracy that got us into this mess. More bureaucracy is the last thing we need. Daft idea but the lad has to look busy so he's had his two-penny-worth.
That's the trouble; everyone will want to have their two-penny-worth. Two hundred and ninety one recommendations will become 291 headings, 500 sub-sets, 1,500 reports and three thousand complications, report-backs, work-groups, committees and a shed-load of costs.
Francis backs away from holding individuals to account. I wonder what would have happened if David Nicholson, boss of the SHA, happened to be working for Sir David Nicholson the boss of the NHS. Would Sir David have given David the sack? Leaders get the organisations they deserve. I listened to Niall Dickson, boss of the GMC, delivering a shambling performance on the BBC's Today programme. Dickson was one of the BBC's finest journalists. I wonder if Dickson the journalist would have let Dickson the bureaucrat off the hook so lightly.
When it comes to structures, Francis abandons his lawyer's forensic for establishment fog. Monitor is to pass most of their powers to the overburdened, drowning CQC. What happens to Monitor? What happens to the market, to regulation? Answers are there none.
The NHS will now infect itself with post-Francis-itis. Expect conferences, seminars, study groups, papers, reports and mind-numbing PowerPoint presentations picking out bits and pieces to suit the organisation and the event and the presenter. That is the problem with Francis. There is something for everyone; it is intricate, detailed and will be twisted, obfuscated and messed about-with. I suspect Francis will generate a multi-million pound industry.
The Francis conundrum is easy; corporate priorities were given precedence over organisational purpose. Answer; give organisational purpose precedence over corporate priorities. I am not sure 291 recommendations really tell us how. Cash will always trump care.
Francis talks about 'culture change'. Effectively making the people we have make the services we've got, work better. On that basis Francis fails. What we've got doesn't work. Never will. Think about it; nearly all the quality problems the NHS faces are around the care of the frail elderly. Why? Because the NHS was never set up to deal with the numbers of porcelain-boned, tissue paper skinned elderly it is trying to cope with. The NHS' customer-base has changed but the organisations serving them have have stood still.
Will Francis 'work'? I have no idea but if I was forced to bet the farm; I'd say no. Francis is complicated when the NHS needs simple. Francis is a jungle and the NHS has a reputation for hiding in the undergrowth.
The massive Francis report will be the NHS' F-word for quite a while. What is missing from his report are a few more 'F' words;
“Fund the front-line fully, protect it fiercely, make it fun to work there, that way you'll make Francis history.”
Have good weekend.