This is a tale of under-staffing, bullying, and a demoralised workforce with staff stretched to the limit and beyond. But it is not a care home or some of the more stressed social work departments. It is (or was) Mid Staffordshire NHS Foundation Trust and a sorry and scandalous tale it is, with direct implications for social workers and social care. 

The public inquiry report by Robert Francis QC (whose opening statement is shown above), should not make easy reading for directors or staff in social services departments. The report is published amid almost weekly reports confirming the growing gap between rising need and falling resources in social care. The perfect storm of rising safeguarding referrals, rising numbers in care, and rising eligibility thresholds is the most obvious consequence. At the same time there are serious and repeated concerns about conditions in some care homes and support for adults needing support from social workers.

Not only are there similarities in the pressures on social care and the NHS, but the regulator and ministers overlap. The Care Quality Commission remains in place as a cross-service regulator despite its failings and the beefed-up inspection and monitoring regime proposed by Francs would certainly impact on social care. Moreover ministers have explicitly made the links, not least as the unsolved issue of integration of health and social care looms large. 

So which of the report’s 290 recommendations have the greatest bearing on social care?

1. The proposed duty of candour would require staff to admit mistakes that have caused “death or serious injury” to patients to their employer as soon as possible and calls for prosecution of employers and managers preventing staff exercising their statutory duty (including whistleblowing over serious concerns). All healthcare providers should also be required by law to inform the patient or relatives of mistakes and provide information to them. There is a separate duty of candour to be imposed on NHS directors to be “truthful” with information they give to healthcare regulators.

2. A proposed beefed-up inspection regime led by the Care Quality Commission including a new power for the Care Quality Commission to police this duty of candour and prosecute organisations and individuals who break the rule.

 

3. Gagging laws against whistleblowers that prevent disclosure of care safety concerns would be banned. 

4. Healthcare assistants would be regulated. At present, the vet who checks your cat is better regulated than the person who looks after your mum in hospital. What will this mean for social care assistants?

5. Senior general managers would have contractually enforceable ethical codes and a “negative register” for the utterly unfit. 

6. Francis says nothing about the Health and Care Professions Council but warns the Nursing and Midwifery Council  that “to act as an effective regulator of nurse managers and leaders, as well as more frontline nurses, [it] needs to be equipped to look at systemic concerns as well as individual ones”. This would surely lead to the HCPC having to beef up its code to provide greater support for whistleblowers and hold bullying managers to account? 

The Francis Report was clear that Stafford was not unique, but was the tip of a much wider problem. Serious problems in social care are getting worse. Bullying is rife. Many staff fear the consequences of raising concerns or speaking up for service users. These system failures caused by poor leadership, a lack of openness and transparency compounded by funding shortfalls are ones social care needs to face up to.

Social workers must always respect the rights of those we work with. The Francis Report reminds all of use that we should do so whatever pressures we face from commissioners or providers to ignore their needs and their voice