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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Jeremy Corbyn's opponents are going down a blind alley on tuition fees

The electoral pool they are fishing in is shallow – perhaps even non-existent. 

The press and Labour’s political opponents are hammering Jeremy Corbyn over his party's pledge/ambition/cruel lie to win an election (delete depending on your preference) to not only abolish tuition fees for new students, but to write off the existing debts of those who have already graduated.

Labour has conceded (or restated, again, depending on your preference) that this is merely an “ambition” – that the party had not pledged to wipe out existing tuition fee debt but merely to scrap fees.

The party’s manifesto and the accompanying costings document only included a commitment to scrap the fees of students already in the system. What the Conservatives and Liberal Democrats are claiming as a pledge is the following remark, made by Jeremy Corbyn in his Q&A with NME readers:

“First of all, we want to get rid of student fees altogether. We’ll do it as soon as we get in, and we’ll then introduce legislation to ensure that any student going from the 2017-18 academic year will not pay fees. They will pay them, but we’ll rebate them when we’ve got the legislation through – that’s fundamentally the principle behind it. Yes, there is a block of those that currently have a massive debt, and I’m looking at ways that we could reduce that, ameliorate that, lengthen the period of paying it off, or some other means of reducing that debt burden. I don’t have the simple answer for it at this stage – I don’t think anybody would expect me to, because this election was called unexpectedly; we had two weeks to prepare all of this – but I’m very well aware of that problem. And I don’t see why those that had the historical misfortune to be at university during the £9,000 period should be burdened excessively compared to those that went before or those that come after. I will deal with it.”

Is this a promise, an aspiration or a target? The answer probably depends on how you feel about Jeremy Corbyn or fees policy in general. (My reading, for what it’s worth, is that the full quote looks much more like an objective than a promise to my eyes but that the alternative explanation is fair enough, too.)

The more interesting question is whether or not there is an electoral prize to be had, whether from the Conservatives or the Liberal Democrats, for hammering Labour on this topic. On that one the answer is open and shut: there really isn’t one.

Why not? Because the evidence is clear: that pledging to abolish tuition fees largely moves two groups of voters: students who have yet to graduate and actually start paying back the fees, and their parents and grandparents, who are worried about the debt burden.

There is not a large caucus of fee-paying graduates – that is, people who have graduated and are earning enough to start paying back their tuition fees – who are opposed to the system. (We don’t have enough evidence but my expectation is that the parents of people who have already graduated are also less fussed. They can see that their children are not crippled by tuition fee debt, which forms a negligible part of a graduate’s tax and living expenses, as opposed to parents who are expecting a worrying future for their children who have yet to graduate.)

Put simply, there isn’t a large group of people aged 21 or above voting for Corbyn who are that concerned about a debt write-off. Of those that are, they tend to have an ideological stance on the value of a higher education system paid for out of general taxation – a stance that makes it much harder for the Conservatives or the Liberal Democrats to peel those votes off.

The whole thing is a bit of a blind alley for the parties of the centre and right. The Tory difficulty at this election wasn’t that they did badly among 18-21s, though they did do exceptionally badly. With the exception of the wave year of 1983, they have always tended to do badly with this group. Their problem is that they are doing badly with 30-45s, usually the time in life that some younger Labour voters begin to vote Conservative, largely but not exclusively because they have tended to get on the property ladder.

Nowadays of course, that cohort, particularly in the south of England, is not getting on the property ladder and as a result is not turning blue as it ages. And that’s both a bigger worry and a more lucrative electoral target for Labour’s opponents than litigating an NME interview.

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to domestic and global politics.