MPS survey on post-Francis culture reveals doctors remain fearful

A week after the government responded to the Francis Inquiry, a survey of hospital doctors conducted by the Medical Protection Society has highlighted the enormous task facing the government in their bid to create the open culture the Berwick Review considered missing and needed in the NHS.

When respondents were asked to comment on the culture of their own Trust following the Inquiry into Mid Staffs, 46% of the 807 hospital doctors responding to the MPS survey admitted they remained fearful of the personal consequences of raising concerns. This is despite 43% acknowledging patient safety concerns were listened to and acted upon.

More worryingly, 65% of the hospital doctors surveyed by MPS believed government’s plans to introduce criminal sanctions on healthcare professionals in cases of wilful neglect will create a culture of fear in hospitals – the very culture Berwick was keen to abolish.

Asked whether they were confident the recent Inquiries by Keogh, Berwick and Clywd into failings in healthcare would have a positive impact on the culture of their organisation, 40% of the doctors expressed little or no confidence at all.

Dr Stephanie Bown, Director of Policy and Communications at the Medical Protection Society said, 'The Medical Protection Society has long argued that better care for patients in the NHS would come through creating the right culture; this cannot be achieved through legislation.

By creating a culture of openness and learning, we believe doctors, nurses and other healthcare professionals will not only be in a position to raise patient safety concerns with confidence that they will be supported, but they will also be in a position to drive continuous improvement in standards of care.

Whilst introducing a new criminal offence for wilful neglect may seem like a strong measure, our survey of hospital doctors shows many believe it is more likely to create a greater climate of fear with the risk of less focus on patients, not more. This is not what the NHS needs.'

The respondents’ experiences of raising concerns gave further insight into the cultural problems that exist within the NHS with 31% admitting to having witnessed incidents of poor patient care that they did not report but they now wish they had. When asked why they had not reported the incident, 67% of the hospital doctors worried they would not be supported by their Trust’s management, 48% were worried they would not be supported by their colleagues and 49% feared the impact raising concerns would have on their career.

Of those respondents that had raised concerns in the past, there was a stark difference in outcomes for the 46% that had raised concerns about a colleague and the 22% that had raised concerns about their organisation.

For those that raised concerns about a colleague, often regarding conduct (49%) and performance (69%), nearly half (47%) stated their concerns had been addressed.

In comparison, those hospital doctors that raised concerns about their organisation, citing issues around poor systems and protocols (74%), staffing levels (72%) and poor resources (54%), only 18% found their concerns were addressed and, disappointingly, 43% reported nothing happened at all.

Asked to reflect on their experience of raising concerns, it is reassuring that 76% confirmed they would raise concerns again. Of the small percentage that admitted they would not raise concerns again (7%), many stated they had lost confidence that concerns will be taken seriously.

Dr. Bown, Medical Protection Society said, 'It is reassuring to see that the majority of hospital doctors who have raised concerns in the past were adamant in our survey that they would do so again.

However, it is disappointing to see so many of the respondents admitting that the concerns they raised, particularly about their place of work, were not addressed.

The Medical Protection Society has long argued that only by being open about patient safety concerns can healthcare professionals and organisations drive improvements.

We hope the government’s plans developed in response to the Francis Inquiry not only ensure staff are empowered to raise patient safety concerns but they also ensure concerns are effectively addressed in a supportive culture with a focus on learning and improvement.'

The Medical Protection Society’s Raising Concerns survey, of hospital doctors in England, was conducted in November 2013.