The Mid-Staffordshire inquiry: where there’s a political will, there’s a way

There are interesting parallels between the Francis report and the Macpherson inquiry report into the death of the black teenager Stephen Lawrence.

We hope and expect that implementation of our Recommendations will ensure that the opportunity for radical thinking and root and branch action is seized. Nothing less will satisfy us and all those who so passionately spoke to us during our hearings

These words are not taken from the long-awaited Francis report, but rather from the Macpherson inquiry report (1999) into the death of the black teenager Stephen Lawrence on a south London street in 1993.  

There are a number of interesting parallels between the Francis and Macpherson reports. Both followed lengthy inquiries into specific incidents involving local "branches" of much wider public services - the Metropolitan Police and Mid Staffordshire NHS Foundation Trust. Each inquiry team was exhaustive in the way it examined the evidence presented to it. Both reports provide a damning analysis of unjustifiable operational, management and systems failings.

Arguably, the real significance of both reports is not simply what they told us about the individual public services concerned, but rather what they revealed about society and our expectations of key public services.  The true relevance of the Francis report is not simply limited to the relatively small number of NHS hospitals; rather, its findings will impact across the whole health and social care system. Just as the Macpherson inquiry report led to systemic changes within the Metropolitan Police and all other police forces, so Francis must trigger a recalibration of all health and social care services, regardless of location, size or the type of organisation providing the service.

All organisations which deliver health and social care services would be wise to spend the next few days and weeks determining what the report’s 290 recommendations mean for their services and the people they care for. Just as it is not possible to read Francis’ weighty report in a single sitting, so it will take a significant period of time for all of us to get our heads around what we need to do as a result.  

The thing which ultimately determines whether such a report sinks or floats; whether its recommendations are fully implemented or gather dust on the shelves alongside so many other reports down the years is political will. The primary reason why people remember the Macpherson report is because the government of the day took its lessons and not only ensured that they triggered change in the Metropolitan Police and the wider police service, but also legislated to ensure that, through the Race Relations Act 2000 (Amendment) and the Race Equality Duty, it led to more wholesale changes to the way all public authorities addressed the issues it raised.

The proposals set out in the Francis report are wide-ranging and ambitious. They include a shift to more patient centred services, an emphasis on zero harm, renewed stress on transparency, fundamental challenges to professional practice and priorities and a wholesale rebalancing of regulation across the health and social care system. The sheer number of recommendations means that it cannot possibly succeed without robust political backing. Day one, at least, suggests that such political will might just exist. The Prime Minister’s decision to deliver the government’s formal response underlined the importance of this issue and hopefully underscores the degree of political commitment to implementing its recommendations.  The Prime Minister’s response made clear that the government is pushing ahead to deal with a number of issues raised by the report.  He has asked Don Berwick to examine how the NHS can implement a "zero harm" approach and Sir Bruce Keogh is reviewing the five NHS Trusts with the highest mortality rates; small steps, but a start nonetheless. The real work and the true test will come over the coming months. Change will require major decisions about the introduction of a statutory Duty of Candour, a fundamental rebalancing of priorities, major shifts in nursing and other care services and a reorganisation of the regulatory landscape with a likely shift in powers between Monitor and the Care Quality Commission and other regulatory bodies.  

The next few months will determine whether there is the political will required to push through the raft of changes to attitudes, perceptions, responses, professional norms and working practices set out by the Francis report. It will also help determine whether, like Macpherson before it, the Francis report is destined to be cited for years to come as a real agent of change, or whether it has more in common with other authoritative reports which have been delayed or simply disappeared from view because of a lack of political will or the absence of a cross-party consensus.     

Dr Phil McCarvill is Head of Policy at Marie Curie Cancer Care
 

Photograph: Getty Images
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The World Cup you’ve never heard of, where the teams have no state

At the Conifa world cup – this year hosted by the Autonomous Republic of Abkhazia – ethnic groups, diaspora communities and disputed territories will battle for footballing glory.

Football's European Championship and the Olympics are set to dominate the back pages over the next few months. How will Team GB fare in Rio? Will the zika virus stop the tournament even going ahead? Will the WAGS prove to be a distraction for the Three Lions? And can Roy Hodgson guide England to a long-awaited trophy?

But before the sprinters are in their blocks or a ball has been kicked, there's a world cup taking place.

Only this world cup is, well, a bit different. There's no Brazil, no damaged metatarsals to speak of, and no Germany to break hearts in a penalty shootout.  There’s been no sign of football’s rotten underbelly rearing its head at this world cup either. No murmurs of the ugly corruption which has plagued Fifa in recent years. Nor any suggestion that handbags have been exchanged for hosting rights.

This biennial, unsung world cup is not being overseen by Fifa however, but rather by Conifa (Confederation of Independent Football Associations), the governing body for those nations discredited by Fifa. Among its member nations are ethnic groups, diaspora communities or disputed territories with varying degrees of autonomy. Due to their contested status, many of the nations are unable to gain recognition from Fifa. As a consequence they cannot compete in tournaments sanctioned by the best-known footballing governing body, and that’s where Conifa provides a raison d’être.

“We give a voice to the unheard”, says Conifa’s General Secretary, Sascha Düerkop, whose world cup kicks off in the Autonomous Republic of Abkhazia at the end of this week.

“We are proud to give our members a forum where they can put themselves on the map.

“From that we hope to give back in the long run and invest in the football infrastructure in our member nations to help them grow.”

The two week footballing celebration starts with an opening ceremony before Kurdistan and Székely Land kick off the tournament. It follows on from 2014’s maiden competition which saw The County of Nice avenging a group stage defeat to Ellan Vannin from the Isle of Man, to take the spoils in the final via a penalty shoot-out.  There were some blowout scores of note however, with South Ossetia smashing Darfur 20-0 and Kurdistan beating the Tamils 9-0 at the event which took place in Östersund, Sweden. Neither of the finalists will be returning to the tournament – throwing down the gauntlet to another twelve teams. 

This, the second Conifa world cup, is testament to the ever-expanding global footprint of the tournament. Abkhazia will welcome sides from four continents – including Western Armenia, the Chagos Islands, United Koreans in Japan and Somaliland.

Despite the “minor” status of the countries taking part, a smattering of professional talent lends credibility to the event. Panjab can call on the experience of ex-Accrington Stanley man Rikki Bains at the heart of their defence, and the coaching savoir-faire of former Tranmere star Reuben Hazell from the dugout. Morten Gamst Pedersen, who turned out for Blackburn Rovers over 300 times and was once a Norwegian international, will lead the Sapmi people. The hosts complete the list of teams to aiming to get their hands on silverware along with Padania, Northern Cyprus, and Raetia.

A quick glance down said list, and it’s hard to ignore the fact that most of the nations competing have strong political associations – be that through war, genocide, displacement or discrimination. The Chagos Islands is one such example. An archipelago in the Indian Ocean, Chagos’ indigenous population was uprooted by the British government in the 1960s to make way for one of the United States' most strategically important military bases – Diego Garcia.

Ever since, they've been campaigning for the right to return. Their side, based in Crawley, has crowdfunded the trip to the tournament. Yet most of its members have never stepped foot on the islands they call home, and which they will now represent. Kurdistan’s efforts to establish an independent state have been well-highlighted, even more so given the last few years of conflict in the Middle East. The hosts too, broke away from Georgia in the 1990s and depend on the financial clout of Russia to prop up their government.

Despite that, Düerkop insists that the event is one which focuses on action on the pitch rather than off it. 

“Many of the nations are politically interested, but we are non-political,” he says. 

“Some of our members are less well-known in the modern world. They have been forgotten, excluded from the global community or simply are ‘unpopular’ for their political positions.

“We are humanitarians and the sides play football to show their existence – nothing more, nothing less.”

The unknown and almost novel status of the tournament flatters to deceive as Conifa’s world cup boasts a broadcast deal, two large stadiums and a plush opening ceremony. Its aim in the long run, however, is to develop into a global competition, and one which is content to sit below Fifa.

“We are happy to be the second biggest football organisation,” admits Düerkop.

“In the future we hope to have women’s and youth tournaments as well as futsal and beach soccer.”

“Our aim is to advertise the beauty and uniqueness of each nation.”

“But the most important purpose is to give those nations that are not members of the global football community a home.”

George Weah, the first African winner of Fifa World Player of the Year award remarked how “football gives a suffering people joy”.

And after speaking to Düerkop there’s certainly a feeling that for those on the game’s periphery, Conifa’s world cup has an allure which offers a shared sense of belonging.

It certainly seems light years away from the glitz and glamour of WAGs and corruption scandals. And that's because it is.

But maybe in a small way, this little-known tournament might restore some of beauty lost by the once “beautiful game”.