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NHS culture

The failures of care at Mid Staffordshire NHS Foundation Trust between 2005 and 2009, documented by Robert Francis QC in his landmark inquiry, were tragic and avoidable.

The Francis Inquiry recommendations make clear that cultural change has now become essential. 

Doctors are uniquely placed to drive this.

Doctors' professional values, commitment to patients and extensive clinical and leadership skills mean they are ideally suited to drive change and work across service boundaries.

However, doctors often report feeling disempowered, conflicted and unable to act wholly in the interests of their patients, citing organisational pressures as barriers.

In 2013 the BMA published discussion papers on professionalism and raising concerns which aimed to bring to the fore the reasons why a negative culture has developed in parts of the NHS and how it can be turned around.

Responses were received to these papers, which have fed into our ongoing work.

Read our discussion paper: Examining professionalism

Read our discussion paper: Supporting doctors in raising concerns

BMA analysis: picking up the pieces

What we are doing

  • Francis Inquiry - next steps

    'It’s now over two years since the publication of the final report into substandard care at Mid-Staffordshire Hospital. At Mid-Staffordshire we saw how patient safety can suffer because of a combination of managerial obsessions and disengaged and disillusioned clinical staff.

    The BMA firmly believes that there needs to be a change of culture across the NHS with medical professionalism put back at the heart of everything we do.

    The NHS has faced unprecedented upheaval over the past year and the financial outlook remains dire as the service struggles to meet budget shortfalls totalling billions of pounds.

    Rather than viewing doctors as being part of the problem, we are calling on the Government and policy makers to recognise the vital leadership role doctors play in driving forward change in order to meet the challenges the NHS faces.

    We support the commitment to put patient care first and foremost, while at the same time looking to create a culture of support – not blame – to empower staff to raise concerns and drive through change.'

    –Dr Mark Porter, Chair of BMA Council

    Read the Government's response to the Francis Inquiry 

    Read more about the Culture Change in the NHS since the report (11 February 2015)

  • Accountability

    We are looking at how quality and patient outcomes are measured in the NHS, and how the new outcomes frameworks can support performance measurement and accountability.

    The BMA will also consider doctors’ roles in using and measuring outcomes data, and how different outcomes are used in decisions for commissioning and patient care.

  • Duty of Candour

    The BMA is liaising with the General Medical Council (GMC) to ensure that the Francis report recommendations are implemented in the best way possible.

    We need to ensure that any new duties will strengthen and improve the system without compromising the existing regulatory framework.

    Individual duty

    The government has stated it will review the proposed duty on individuals following the publication of the Berwick Review of patient safety, commissioned by the Government following the Francis Report.

    In a letter to the BMA  the Secretary of State for Health Jeremy Hunt has indicated that the government might look to apply existing methods of criminal prosecution more effectively.

    Read the health secretary's letter to the BMA on duty of candour

    View the Berwick Review into patient safety

    Our position

    The BMA supports the principle underlying the idea of a duty of candour and believes that all NHS staff must be honest and transparent in everything that they do in order to best serve and protect their patients.

    The existing professional duties on doctors to be open and honest with patients about their care, and the sanction for any failure, underpin these standards.  There are already a number of ways in which healthcare workers, including doctors, can be prosecuted using both criminal and civil proceedings in connection with dishonest behaviour or action endangering patients.

    We believe the introduction of a statutory duty of candour with criminal sanctions for individuals would not add anything substantive to the existing routes and could have the opposite effect of that intended. The threat of criminal prosecution for an act committed in the course of treating a patient (whether accidentally, negligently or purposefully) could, instead, worsen the culture of fear amongst professionals that prevents people speaking out.

    However, we do support the proposed new statutory duty of candour on organisations as the existing mechanisms for holding providers to account require strengthening.

    View our full briefing and position on a statutory duty of candour

  • Leadership

    We are focusing on medical management, leadership and how the BMA can further support its members to promote a positive and open working culture. This includes identifying and addressing conflicts within medical management, how to empower managers at all levels to lead by example, and identifying the competencies and values required of medical leaders.

  • Learning from others

    What can we learn from other organisations outside the NHS? How do they manage safety issues and what can we learn from their organisational culture? We are looking at other organisations to explore their attitudes towards building a positive organisational culture.

  • Public involvement

    The BMA is working with its Patient Liaison Group (PLG) to look at how best to facilitate an open and trusted dialogue between doctors, patients and the public.

    We aim to raise awareness and understanding of the need for meaningful patient and public engagement across the NHS.

    Find out more about the Patient Liaison Group

  • Raising concerns

    The BMA submitted a response to the Freedom to Speak Up review led by Sir Robert Francis.

    Read our submission to the review

    Read Sir Robert Francis' report: Freedom to speak up

    The BMA also provides support for members raising concerns through its employment advice services and practical guidance.

    Go to raising concerns