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Report 'should be NHS watershed'

The Francis Report into hospital care failings should be a "watershed for the NHS" which gives staff greater freedom to raise the alarm over poor standards, health experts say.

The report, ordered in the wake of hundreds of avoidable deaths at the Mid-Staffordshire NHS Foundation Trust, recommended that staff be given a legal "duty of candour" to reveal bad practice and be open with the families of the deceased.

The report into events at the trust between 2005 and 2009 called for a "zero tolerance" approach to poor standards in the health system.

Organisations representing health service staff said that the proposed changes should be accepted to allow whistleblowers to speak out without fear of retribution from management.

Dr Mark Porter, the British Medical Association's chairman of council, called for a new culture of zero tolerance to poor and dangerous care.

"It is not enough to say that lessons must be learnt," he said.

"It is essential that we all - politicians, NHS organisations, doctors, managers, nurses, and patient groups - work together to develop a different kind of health service where the system will not tolerate poor quality of care.

"As with every other area in life, providing healthcare is not risk-free and it never will be; the art and science of medicine is in balancing those risks.

"But we must create an urgent shift towards a more open and transparent approach that values learning from mistakes and puts the patient experience at the centre of our thoughts and reflections.

"Despite all the regulations and guidance to help staff raise concerns, a climate of fear, bullying and harassment can stop clinicians from speaking out.

"Unless and until medical staff and management jointly promote the ethos that raising concerns is not only acceptable but a positive thing, the shadow of Mid Staffs will put us all into darkness."

The report should be a "watershed for the NHS" that gives staff greater freedom to raise the alarm over poor standards of care, the Royal College of Midwives said.

Cathy Warwick, its chief executive, said often midwives were "petrified" of whistleblowing for fear that senior management would punish them.

A duty of candour recommended by the Francis report should change that, she said.

"We need to transform the culture of the NHS so that midwives and others who need to raise concerns feel happy and secure in doing so," she said.

"NHS staff must never again be afraid to raise concerns about standards of NHS care. Today must be a watershed for the NHS."

She said the RCM also welcomed a new system that will hold senior managers in particular accountable for their actions, with the power to disqualify those who were found to be unfit for their post.

It also backed a recommendation that the National Institute for Health and Clinical Excellence (Nice) would be asked to set minimum safe staffing levels for the NHS.

Professor Norman Williams, president of the Royal College of Surgeons, said: "The catalogue of neglect, squalid bedside humiliation and unnecessary deaths are beyond comprehension to those of us who came into the NHS to care for patients and make them better.

"The proposal of a set of fundamental standards to underpin the delivery of high-quality care, defined by what patients want and influenced by the expertise of the Royal Colleges, will act as a catalyst to improve care."

The Royal College of General Practitioners described Mid Staffordshire as a system failure of the highest order.

Dr Clare Gerada, its chairwoman, said: "Unfortunately, it demonstrates the extreme consequences of what can happen when the NHS loses sight of patient care on the ground in the scramble to balance budgets and achieve targets.

"Hospitals should be places where people feel safe and where they can trust the staff looking after them to deliver the care and kindness they deserve. They should not be institutions that strike fear and dread into the hearts of patients, in many cases even before they are admitted."

The Royal College of Physicians said that parts of the NHS system must change to better meet patients' needs.

Dr Patrick Cadigan, registrar of the RCP, said: "We welcome the emphasis on frontline healthcare professionals in ensuring the delivery of high quality care and strongly support the view that a named senior clinician should take responsibility for each patient. Care of older people should be improved in hospitals and team work is crucial to this."

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