Human Rights, The Francis Report and beyond…… improving patient care

Whilst the release of the Francis Report has been eagerly awaited, let’s hope it makes a difference to patient care. Sadly many of the findings will probably not be new.

The Equalities and Human Rights Commission published a report in 2009 which highlighted many of the problems that persist currently in the sector. The Equality and Human Rights Commission conducted an inquiry to establish the extent to which human rights are embedded in service provision across England and Wales. 2,855 individuals provided evidence to the inquiry between April and December 2008. The aim of the inquiry was to identify barriers to the delivery of human rights and identify good practice to support the promotion of human rights.

The report from the Inquiry identified some of the everyday situations in which Human Rights were breached by public authorities

• Unexplained death in prisons, police stations and hospitals (Article 2)
Not being able to eat properly while in hospital or a care home (Articles 2 and 8)
• Provision of facilities or food which do not meet religious or cultural needs (Article 9)
• Abuse or neglect of older people, those who are learning disabled or other vulnerable people (Articles 2 and 3)
• Lack of respect for privacy on a hospital ward (Article 8)
• Unexplained death in prisons, police stations and hospitals (Article 2)

The report includes an interesting chapter on leadership (Chapter 5) which emphasised the need for cultural change, starting at the top with Government which then flows downward to those with leadership and management responibilities across the NHS. Does the Francis Report make a similar point?

If it does this will require a change in approach from leaders and managers across the sector, a change from a transactional style of leadership and management to one that is transformational. Transactional leadership is based on bureaucratic authority with an emphasis on task orientated goals. An organisation characterised by a transactional management structure leads to the development of a ‘defensive culture’ where members are expected to conform and follow rules without challenge.

However, transformational leadership is a process that motivates followers by appealing to higher ideals and moral values. Transformational leaders must be able to define and articulate a vision for their organisations, and the followers must accept the credibility of the leader. Organisations characterised by transformational leadership are more likely to have a ‘constructive culture’ where members experience constructive cultural norms, for example, organisations set challenging but realistic goals and manage in a participative manner where relationships are constructive and open so as to achieve agreed goals. This is not to suggest transactional leadership and management is not also required in some measure, however, the transactional approach seems to have carried greater emphasis across health and social care than the transformational, and this has been supported by managerial approaches incorporated from the business sector.

A human rights approach can provide a solid foundation for transformational leadership. Chapter 6 of the above mentioned report found where public sector providers embrace a human rights based approach they reported improved services along with better and more coherent delivery procedures and heightened staff morale. The Commission identified the positive effect a human rights based approach can have on patients following a change in culture within NHS trusts. Whether government accepts it or not The Human Rights Act does provide a common framework of values that can be useful for managing competing financial tensions and ethical obligations within the NHS.

Adherence to a culture of human rights has the ability to provide organisations with a clear framework on which to hang the transformation of health and social care provision. To achieve this those in leadership positions need to actively view their role as securing human rights for individuals because what is missing, perhaps, is a consciousness of the activities of large organisations as working toward promoting a basic human right for patients to be treated with dignity and respect by everyone employed in their organisation.

I read an interesting article in the Harvard Business Review which made a distinction between ‘leadership’ and ‘management’, suggesting large organisations are over managed and under-led. They may have a point.

About digalpin

I gained my social work qualification from the University of Southampton and worked for 14 years in mental health, disability and older people services. I am currently a senior lecturer in post-qualifying social work at Bournemouth University and am conducting research on government and societal attitudes and responses to the mistreatment of older people in health and social care provision for my doctorate. My views are my own.

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