Mid Staffs matters to care of all children

But the 290 recommendations and messages of the Francis Report into the failings are as important for children’s social care services as they are for the battered NHS.

In 1749, the British Lying-In Hospital was established in London. It catered for the “distressed poor” (married women only, of course), with special attention given to the wives of soldiers and sailors. From almost the outset and on leaving the hospital after the mothers “gave thanks” on departing, the hospital’s board quizzed them about their stay, in order to tease out any complaints. In 1750, it was reported that “patients’ disappointment over rancid caudle, bedbugs and neglect by the female staff led to immediate investigations and remedies, including the firing of negligent staff” or – on the other side of this coin – the withdrawal of charity when complaints were seen to be false or malicious.

So, why is it that over 250 years later we still don’t listen to patients, ignore the messages from young people abused in residential care or manage to gloss over the institutional harm done in some nursing or care homes? Despite all of the mantras about “no decisions about me without me” or a few years ago, the test of former Health Secretary Frank Dobson, “is this good enough for my child?”, we are regularly reminded that services sometimes don’t listen to the most important voice in the equation – the patient or client.

I suspect the reasons for this neglect have become more complex as, indeed, have services. The hospital board in 1749 could more readily accommodate listening to ex-patients than could the chief executive interviewing families as they left Manchester Children’s Hospital. What is also new is the distorted view of reality, which has led to a series of performance indicators that are so divorced from what happens on the wards that the real needs of patients are ignored. It is, returning to Francis, more about “a culture based on doing the system’s business – not that of the patients”.

Time is probably another modern factor, alongside complexity. Numerous reports have, for example, pointed to the way in which social workers’ case notes revealed that when visiting looked-after children in foster care, it was seldom the children who were interviewed. Their views were seen to be known by their carers. No wonder abuse was not spotted; because, of course, getting alongside people to determine their true views takes time and patience.

It is, at one level, a gross embarrassment that the Who Cares? movement, which grew out of a National Children’s Bureau initiative in the 1970s, was such a revelation in pointing out that you can develop much better services if you empower and listen to the young people who live in them.

Patient and client voices are, of course, also often silent because of the unequal power relationships that make whistleblowing difficult in many settings. Guaranteeing both anonymity and safety through the process, without subsequent reprisals, is not something that can be undertaken lightly. It is to be hoped that the considerable emphasis that Robert Francis puts on whistleblowing will reverberate throughout the whole of health and social care.

And, lastly, interpreting feedback from patients and clients is complicated when statutory powers are being invoked. The compulsory detention of people under mental health legislation or the removal of children at risk is not something that usually endears people to these legal functions. A skilled path is needed to disentangle litigious complaints from genuinely maintained views on the quality of some interventions.

Mid Staffordshire is, primarily, a tragedy for all of those families caught up in the hospital’s poor treatment. But it is also a wake-up call for the whole of children’s services that we ignore at our peril.
 
Dr Chris Hanvey is chief executive of the Royal College of Paediatrics and Child Health