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
Photo: Getty Images
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The buck doesn't stop with Grant Shapps - and probably shouldn't stop with Lord Feldman, either

The question of "who knew what, and when?" shouldn't stop with the Conservative peer.

If Grant Shapps’ enforced resignation as a minister was intended to draw a line under the Mark Clarke affair, it has had the reverse effect. Attention is now shifting to Lord Feldman, who was joint chair during Shapps’  tenure at the top of CCHQ.  It is not just the allegations of sexual harrassment, bullying, and extortion against Mark Clarke, but the question of who knew what, and when.

Although Shapps’ resignation letter says that “the buck” stops with him, his allies are privately furious at his de facto sacking, and they are pointing the finger at Feldman. They point out that not only was Feldman the senior partner on paper, but when the rewards for the unexpected election victory were handed out, it was Feldman who was held up as the key man, while Shapps was given what they see as a relatively lowly position in the Department for International Development.  Yet Feldman is still in post while Shapps was effectively forced out by David Cameron. Once again, says one, “the PM’s mates are protected, the rest of us shafted”.

As Simon Walters reports in this morning’s Mail on Sunday, the focus is turning onto Feldman, while Paul Goodman, the editor of the influential grassroots website ConservativeHome has piled further pressure on the peer by calling for him to go.

But even Feldman’s resignation is unlikely to be the end of the matter. Although the scope of the allegations against Clarke were unknown to many, questions about his behaviour were widespread, and fears about the conduct of elections in the party’s youth wing are also longstanding. Shortly after the 2010 election, Conservative student activists told me they’d cheered when Sadiq Khan defeated Clarke in Tooting, while a group of Conservative staffers were said to be part of the “Six per cent club” – they wanted a swing big enough for a Tory majority, but too small for Clarke to win his seat. The viciousness of Conservative Future’s internal elections is sufficiently well-known, meanwhile, to be a repeated refrain among defenders of the notoriously opaque democratic process in Labour Students, with supporters of a one member one vote system asked if they would risk elections as vicious as those in their Tory equivalent.

Just as it seems unlikely that Feldman remained ignorant of allegations against Clarke if Shapps knew, it feels untenable to argue that Clarke’s defeat could be cheered by both student Conservatives and Tory staffers and the unpleasantness of the party’s internal election sufficiently well-known by its opponents, without coming across the desk of Conservative politicians above even the chair of CCHQ’s paygrade.

Stephen Bush is editor of the Staggers, the New Statesman’s political blog.