Inspection and Regulation

Round-up of the best responses to the Francis report

RCN chief executive & general secretary, Dr Peter Carter, called the report “powerful and monumental” and stated his support for the regulation and registration of health care assistants.

The RCN was one of the many organisations that came in for specific criticism in the report, and Dr Carter said: “The RCN is acutely aware that it has real lessons to learn from how it supported members locally at Mid Staffs. Although we have already put in place numerous measures, we will look at the report in depth to see what other steps we can take to improve our effectiveness.”

Gail Beer, director of operations at 2020health, stated: “The focus on behavioural change not organisational change will present a real challenge to NHS leaders and managers…Doctors and nurses must also step up to the leadership challenge posed by Francis, and not shy away from managing colleagues, however uncomfortable it may be.”

The Academy of Medical Royal Colleges (AoMRC) said: “Quality of care must be the foremost priority for all involved in the delivery of health services. All professionals from the medical and nursing profession to managers have a share in the responsibility for this failing.

“We believe that poor care is not everywhere in the NHS but has the potential to happen anywhere.”

Mike Farrar of the NHS Confederation said: “This is a hard hitting but fair analysis of what happened in Mid Staffordshire and that is exactly what we needed.”

He added that the NHS should applaud the core objective of putting patients at the centre of the system and called it “an opportunity to make the NHS safer, more compassionate and fully accountable to the people it serves”.

Dean Royles, director of NHS Employers, part of the NHS Confederation, said the report called for a “long hard look” at leadership and care in every level of the NHS.

“If we get it right, Francis can become a byword for improvement rather than failure.”

The Leadership Group of NHS Clinical Commissioners, on behalf of NHSCC, said it made “uncomfortable reading” for anybody working in the NHS and detailed a “clear…collective responsibility” to ensure the failures of Mid Staffordshire are not repeated.

The group stated: “We will use the levers available to CCGs through the commissioning process, clinical engagement and public involvement to drive up quality.”

Engagement with the front line of general practice would also be central to fulfilling the recommendations of the report and “where necessary we will challenge clinicians from our providers”, they said.

Monitor said in a statement that it “profoundly and sincerely regrets the events that took place at Mid Staffordshire NHS Foundation Trust” deeming the standard of care as “shocking” and “unacceptable”.

“We accept without hesitation our share of responsibility for failures in regulation during the period in question. We authorised a trust which in retrospect should not have been authorised and could have used our formal intervention powers sooner once problems had been uncovered.

“We have learnt from the mistakes we made and have already made significant changes to the way we work as a result of what happened at Mid Staffordshire.”

Jan Sobieraj, managing director of the NHS Leadership Academy, called it a “watershed moment for the NHS”.

He said: “What happened in Mid Staffordshire was not one person, nor was it one group of nurses or doctors or managers.”

Sonieraj wholly endorsed the report’s recommendations and added: “There is no quick fix but what we do know is that there is a lot of evidence that tells us that leadership development is crucial to improving the safety and quality of patient care.”

Niall Dickson, chief executive of the General Medical Council, said that patients had been let down “very badly” by the health system and said the report “exposes fundamental failings that allowed poor care to go unchecked and a culture to develop which led to catastrophic results.”

He added: “Changing culture will not be achieved overnight – it requires commitment from all levels of the healthcare system, but if we are to avoid more tragedies we need to tackle this problem now.”

Director of policy at The King’s Fund, Anna Dixon, said the emphasis on culture, better leadership, training, information and transparency was the right approach. “It is clear that the causes of the Mid Staffs scandal are deep and complex, and the solutions are equally diverse.”

But she warned: “Even if all 290 recommendations were implemented now, the fundamental shift in culture can only be achieved if patient care is put top of the agenda for boards and is the first responsibility of professionals working in the NHS. That will take time and commitment over many years.”

Chief executive of Turning Point, Lord Victor Adebowale, who sits on NHE’s editorial board, said: “We need to ensure that patients and communities are seen as equal partners in the design and delivery of services. Only by embedding the patient and community voice at every level of support, by listening and acting on it, can we ensure services meet the individual’s and community’s needs.”

Cathy Warwick, chief executive of the Royal College of Midwives, welcomed the recommendations for minimum staffing levels and regulation of healthcare assistants. She said: “We need to transform the culture of the NHS so that midwives and others who need to raise concerns feel happy and secure in doing so.

“It is good news too to see a tough new system that will hold senior managers in particular accountable for their actions. The power to disqualify those who prove themselves unfit to manage the NHS is a massive step forward and matches the rules that currently apply to midwives and are being rolled out to doctors.”

Rick Stern, chief executive of the NHS Alliance, said: “There was clearly a failure in systems, and there had been a focus on the institution and processes, instead of the patient population.

“It may be tempting to call for more rules and stronger regulation to ensure that this never happens again. But at the heart of the failure at Mid Staffordshire was a culture where people felt unable or unwilling to challenge what was going on, and to ensure that caring for people and making sure that they are safe is always placed above finances. There will need to be a cultural change, with a new emphasis on the power of the patient voice.”

Nursing and Midwifery Council (NMC) chief executive, Jackie Smith, said: “We were part of a system which went badly wrong, and we sincerely apologise to those many people and their families who suffered.”

Dianah Pritchett-Farrell, chair of the Foundation Trust Governors Association (FTGA), said the recommendation for the Duty of Candour was “vital” and added: “Our members can’t do their jobs if trusts don’t consistently share information about the way they measure and understand the performance of professionals, teams and managers.”

Professor Richard Parish, chief executive of RSPH said: “Professional bodies should take the lead in changing the culture of the NHS. This must be a shared responsibility between clinical leadership and general management.”

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Image c. Dominic Lipinski and PA Wire