Francis calls for records and open data

Robert Francis QC has backed investment in electronic patient records and the wider publication of NHS data at the end of his inquiry into the scandal at Mid Staffordshire NHS Foundation Trust.

In his 1,700 page report into high death rates and appalling care at Stafford Hospital, and why senior managers and regulators failed to act for so long, he discusses why inital concerns became bogged down in arguments about whether its apparently high death rates were a statistical or real problem.

His first inquiry, published in 2010, called for a new mortality indicator. This has since been introduced, although Francis would like to see it further developed.

However, his new report, presented to Parliament and a news conference this morning, focuses more attention on the need to collect real-time information on patients and the care they are receiving.

In speech to the press conference, he said: “A common culture of serving and protection patients and of rooting out poor practice will not spread throughout the system without insisting on openness, transparency and candour everywhere within it.

“Transparency means making accurate and useful information about performance and outcomes available to staff, patients, the public and regulators [and] information provided to the public about performance should be required to be balanced, truthful and not misleading by omission.”

The report notes that since the scandal, the government has published a new information strategy for the NHS – ‘The Power of Information’ – and describes this as a “potentially very important development."

“If patient records can be used to provide data that directly informs effective safety, quality and performance measures, there is a potential for increasing the accuracy and timeliness of those mechanisms,” it adds.

The report also says that patients should have access to both their own records and other data sources.

“From the patient’s point of view, swift, online access to their records, with a facility to note their own comments, can only serve to enhance their involvement in their own treatment and to improve its accuracy and completeness.”

The scandal at Mid Staffordshire first started to emerge in 2007, when Dr Foster and the Healthcare Commission, the forerunner of the Care Quality Commission, raised concerns about high death rates.

The HC went on to launch an inquiry, which was followed by the first of Francis’ inquiries into what had gone on at Stafford Hospital. This report, in 2010, said there were not only high death rates but appalling care in A&E and on some wards.

The subsequent public inquiry was set up to find out why it had taken so long for the scandal to break, and what could be done to stop similar failures. As part of the public inquiry, which has taken more than two years, Francis ordered seminars on information systems and patient feedback.

Reflecting on the seminar, today’s report says that better information “does not require a vast computer system applied throughout the country” and that “efforts in that direction have not succeeded.”

Instead, the report says “there is a need for all to accept common information practices, and to feed performance information into shared databases for monitoring purposes.”

One way and another, the report argues that new indicators and monitoring systems should be based on information “collected about individual patients and recorded by those clinically responsible for their care” in such a form that it can be aggregated and analysed.

It says that trust boards should be given the responsibility for making sure there are “effective systems of recording, analysis and publication of local performance indication” and that this should be monitored by the regulator.

It also calls for boards to take more responsibility for the publication of quality accounts, and for there to be new legal offences of giving out misleading information.

Finally, it calls for public access published information via “a user-friendly information gateway” and says that “access to raw, anonymised information should be available to any organisation or individual intending in good faith to undertake their own analysis and having the competence to do so.”