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Poor NHS care could lead to prosecution – Francis report

NHS staff should be prosecuted if patients die or are caused harm by failings in care, the Francis report into the Mid Staffordshire scandal has recommended.

He suggests: “Provision should be made for regulatory intervention to require removal or suspension from office after due process of a person whom the regulator is satisfies is not or is no longer a fit and proper person, regardless of whether the trust is in significant breach of its authorisation or licence.”

Today’s 3,820-page report by Robert Francis CQ, chair of the public inquiry into the failure of NHS managers and regulators to identify and act on problems at Stafford hospital has been published today, with nearly 300 wide-ranging recommendations.

Horrifically low levels of care led to between 400 and 1,200 deaths at the hospital between 2005 and 2009, and caused untold amount of suffering for many patients.

The report calls for the Nursing and Midwifery Council (NMC) to regulate healthcare assistants, and Monitor and the CQC should merge, maintaining their current funding. Tougher entry requirements have been proposed for student nurses, directors of NHS providers should be subject to a new fit and proper person test and new legislation could require all staff and directors to be honest about their errors.

Francis, who also handled one of the previous NHS inquiries into failings at the trust, has proposed a ‘duty of candour’ for staff to speak up when their mistakes affect patients. A new post, chief inspector of hospitals, should be created, and regulation should be strengthened through more and further-reaching inspections.

He did not directly criticise individual NHS leaders, such as Sir David Nicholson, to the surprise of some and the consternation of campaigners and families affected who see him as culpable.

Teams of inspectors should include more doctors and nurses and there should be better collection and sharing of different sources of information about hospital care between different regulators.

Francis said: “Any service or part of a service that does not consistently fulfil the relevant fundamental standards should not be permitted to continue.

“Non-compliance with a fundamental standard leading to death or serious harm of a patient should be capable of being prosecuted as a criminal offence, unless the provider or individual concerned can show that it as not reasonably practical to avoid this.”

The report includes 290 recommendations. Prime Minister David Cameron is due to respond in Parliament at 12.30pm today.

NHS Confederation chief executive Mike Farrar said: “The culture of that organisation was not geared up to put patients' needs right at the heart of it; there was almost an institutionalised blindness to what mattered.

“The risk, I think, today, is that we look to external things like better regulation or more inspection, to try to solve what effectively is a problem that can really be only solved by having a culture in every hospital where every member of staff is geared up to try and provide the best possible care for patients.”

Katherine Murphy of the Patients’ Association said: “A fundamental shift in the culture of NHS organisations so that both appalling and good care are viewed as learning opportunities is crucial.”

David Welbourn, Visiting Professor in the Practice of Health Systems Management at The Centre for Health Enterprise (CHE), Cass Business School, City University London said: “We understand the temptation to impose punitive controls on a system that demonstrably failed to understand its core purpose. But the danger of such populist intervention is that it will exacerbate the very cultural flaws that created the hole into which Mid Staffordshire Hospitals Trust fell. At its heart, there is only one sure-fire way forwards. The solution must lie in reinforcing the statutory duty Board directors already have. This is hard and difficult stuff.”

Gail Beer, director at 2020health and former hospital director warned against too much focus on bureaucracy instead of culture: “As sector regulators, CQC and Monitor need to be totally separate from the NHS so they have the freedom to test and challenge without any political pressure being brought to bear. At the moment only the Health Select Committee seem to have a truly independent voice.”

Julia Manning, CEO of 2020health, who sits on NHE’s editorial board, added: “Professionals need to see patients as equals – intimidation and arrogance is intolerable – and they should welcome involvement, be it as volunteers onto wards or supporting advocacy roles for other patients.

“Ultimately clinicians and managers at all levels need to accept – must be made to accept – that when things go wrong, the right response is to humbly sit down with those involved, talk through the issue and apologise.”

This page will be updated with the latest comment and reaction as it is published. For more live news on the Francis report, follow @nhewnews

Tell us what you think – have your say below, or email us directly at

(Image of Robert Francis QC: David Jones/PA Archive/Press Association Images)

15:00 Prime Minister David Cameron has responded to the report. He said: "This government has put compassion ahead of bureaucratic process-driven targets and put quality of care on a par with quality of treatment.

"We have set this out explicitly in the Mandate to the NHS Commissioning Board, together with a new vision for compassionate nursing. We have introduced a tough new programme for tracking and eliminating falls, pressure sores and hospital infections. And we have demanded nursing rounds every hour, in every ward of every hospital.

"But it is clear we need to do more. We will study every one of the 290 recommendations in today’s Report and respond in detail next month."

His full speech can be found here.


Concerned NHS Worker   06/02/2013 at 13:06

The Government has to take a share of any 'blame' in that it stipulates too many targets, which in reality, piles the pressure on the 'caregivers', thus taking away patient focus in order to tick the boxes (and gain financial benefit!). Hospital Senior Managers must take things back and focus on a Patient Centred approach.

Michelle R   06/02/2013 at 13:11

It appears that the link within the report is for that of Volume I not today's report Volume II.

Concerned Employee Of The Nhs   06/02/2013 at 13:12

There is mention of prosecution for a criminal offence. This already exists through health and safety law. There is clear evidence of system failures which in any other industry would have resulted in prosecution by the HSE! why is the NHS exempt?

Ziggy   06/02/2013 at 13:39

"He did not directly criticise individual NHS leaders, such as Sir David Nicholson, to the surprise of some and the consternation of campaigners and families affected who see him as culpable." And that is a very great shame. Of course there should be prosecution. No more musical chairs & enhanced pensions, please!

Editor   06/02/2013 at 14:03

Michelle - link corrected, thanks for spotting that. 'Concerned employee' - from what David Cameron has said today, the Government's going to "consider carefully" transferring those powers from the HSE (seen as too far from NHS/hospitals) to the CQC. Hopefully while providing the CQC with adequate resources to do so!

Simon Ellis   08/02/2013 at 08:56

Stafford was the result of a bullying culture with a management focused on targets and money. This bullying culture comes down the chain from the Department of Health down to the Executives in the hospital and the directorate mangers who in tern bully and harass the ward managers and give them too few staff. This uncaring attitude eventually and inevitably communicates itself to the healthcare who is actually making sure Mrs. Jones has a drink and is lying in clean sheets. Francis has got it wrong if he thinks prosecuting healthcare workers is going to help. What is needed is less fear and more compassion.

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