In sickness and in health

So a day dominated by health issues. The reverberation of the Francis Report continues to echo. How right he is on the central conclusion that the culture of the NHS has become driven by corporate self interest and cost control instead of patients and their safety.

That's damning: but that is in fact what many ACEVO members report from their own client’s experience. I had lunch with Jeremy Hughes of the Alzheimer’s Society and he said they reported a 48% dissatisfaction rate with services in that they believed their relative or friend came out of hospital worse than when they went in.

So can the culture change? Many of the professional groups understand the desire for change. It was interesting listening to Naill Dickson of the BMA this morning talking about the need for Doctors to challenge and report on bad care. I hope the new CCGs will start to use their commissioning power to decommission bad care and to put quality of care as a key component in making decisions on who provides.

There are many calls for sackings and resignations. It is indeed strange no one seems to be taking the can for what is the most gross abuse. On the same day as Francis, RBS were saying that the people involved in their own Libor scandal were sacked.

But whatever the desire to see culprits pay the key is to see how things can be changed. I'm confident that David Nicholson has seen the need for radical shifts and will drive that. He has the standing to secure such a radical shift in attitudes. He must now ensure the new Commissioning Board put patients first. So the Nicholson challenge is not to find £20bn of savings but to implement a patient first culture. He has had a chastening experience. He can use that for good. And he must.

But culture change must always be backed by legal and process changes. So we must have a legal duty of candour. And this is the time to revisit a key recommendation of my Report on Choice and Competition; to introduce a legal right to challenge bad service delivery. So in future patients and relatives who did see what managers wilfully ignored, can tackle bad care by demanding a new provider.

I think we in the charity sector can claim we run organisations that do put patients above cost and have a Culture that welcomes and encourages patients and citizens.

This was something we were discussing at an ACEVO roundtable with the DH and Cabinet Office this morning. A group of our health members were debating how we get a grip on the new commissioning structures and the need for collaborative approaches and alliances between charities and between other providers in hospitals and the private sector. We have developed great partnerships on campaigning; the dementia alliance, the disability groups etc. But we have been less good at putting together consortia to bid. And we need to. So that will be a challenge for ACEVO to see how we can support that movement.

And to cap of my health day I had a long conversation with the CEO of the Migraine Trust, one of those brilliant small national organisations that do effective work in supporting the many people who have this debilitating condition but for whom their Doctors keep prescribing paracetamol or a brain scan!