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 strange death of boozy Britain: why are young people drinking less?

Ditching alcohol for work.

Whenever horrific tales of the drunken escapades of the youth are reported, one photo reliably gets wheeled out: "bench girl", a young woman lying passed out on a public bench above bottles of booze in Bristol. The image is in urgent need of updating: it is now a decade old. Britain has spent that time moving away from booze.

Individual alcohol consumption in Britain has declined sharply. In 2013, the average person over 15 consumed 9.4 litres of alcohol, 19 per cent less than 2004. As with drugs, the decline in use among the young is particularly notable: the proportion of young adults who are teetotal increased by 40 per cent between 2005 and 2013. But decreased drinking is not only apparent among the young fogeys: 80 per cent of adults are making some effort to drink less, according to a new study by consumer trends agency Future Foundation. No wonder that half of all nightclubs have closed in the last decade. Pubs are also closing down: there are 13 per cent fewer pubs in the UK than in 2002. 

People are too busy vying to get ahead at work to indulge in drinking. A combination of the recession, globalisation and technology has combined to make the work of work more competitive than ever: bad news for alcohol companies. “The cost-benefit analysis for people of going out and getting hammered starts to go out of favour,” says Will Seymour of Future Foundation.

Vincent Dignan is the founder of Magnific, a company that helps tech start-ups. He identifies ditching regular boozing as a turning point in his career. “I noticed a trend of other entrepreneurs drinking three, four or five times a week at different events, while their companies went nowhere,” he says. “I realised I couldn't be just another British guy getting pissed and being mildly hungover while trying to scale a website to a million visitors a month. I feel I have a very slight edge on everyone else. While they're sleeping in, I'm working.” Dignan now only drinks occasionally; he went three months without having a drop of alcohol earlier in the year.

But the decline in booze consumption isn’t only about people becoming more work-driven. There have never been more alternate ways to be entertained than resorting to the bottle. The rise of digital TV, BBC iPlayer and Netflix means most people means that most people have almost limitless choice about what to watch.

Some social lives have also partly migrated online. In many ways this is an unfortunate development, but one upshot has been to reduce alcohol intake. “You don’t need to drink to hang out online,” says Dr James Nicholls, the author of The Politics of Alcohol who now works for Alcohol Concern. 

The sheer cost of boozing also puts people off. Although minimum pricing on booze has not been introduced, a series of taxes have made alcohol more expensive, while a ban on below-cost selling was introduced last year. Across the 28 countries of the EU, only Ireland has higher alcohol and tobacco prices than the UK today; in 1998 prices in the UK were only the fourth most expensive in the EU.

Immigration has also contributed to weaning Britain off booze. The decrease in alcohol consumption “is linked partly to demographic trends: the fall is largest in areas with greater ethnic diversity,” Nicholls says. A third of adults in London, where 37 per cent of the population is foreign born, do not drink alcohol at all, easily the highest of any region in Britain.

The alcohol industry is nothing if not resilient. “By lobbying for lower duty rates, ramping up their marketing and developing new products the big producers are doing their best to make sure the last ten years turn out to be a blip rather than a long term change in culture,” Nicholls says.

But whatever alcohol companies do to fight back against the declining popularity of booze, deep changes in British culture have made booze less attractive. Forget the horrific tales of drunken escapades from Magaluf to the Bullingdon Club. The real story is of the strange death of boozy Britain. 

Tim Wigmore is a contributing writer to the New Statesman and the author of Second XI: Cricket In Its Outposts.