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Reaction to the Francis Inquiry report: AS IT HAPPENED

The live blog is now over

17.13 Department of Health Permanent Secretary Una O’Brien said: ‘On behalf of the Department of Health, I would like to apologise wholeheartedly for the part the Department played in the failings at Mid Staffs and the terrible impact it had on patients, their families and the standards of care.’ The DH released a statement saying it will be considering in full the recommendations made in the report, and will be responding in further detail next month.

15:44 CQC responds to publication of Francis report, saying: ‘Today’s statement by the Prime Minister sets clear objectives for CQC which strengthens our role as regulator. We will continue to operate as a single, unified regulator across health and social care.’

15.31 Statement from the NHS Commissioning Board claims ‘action on many of the concerns identified by the Francis report is already underway or planned’. It says: ‘There is much more to do but we hope people can see that the journey has begun. We are determined to repair the damage to public confidence.’

15:16 GMC chief executive Niall Dickson says the report demonstrates the rationale for revalidation. He says: ‘The system as a whole needs to get much better at spotting problems and intervening earlier to protect patients from harm and we are determined to play a part in that. For us, the new system of checks on doctors, known as revalidation - which started at the end of last year - will enhance our ability to improve the quality of medical practice as a whole.’ Mr Dickson also reveals they have investigated 42 doctors from Mid-Staffs, sent formal letters to 22 advising them about their future conduct, put formal restrictions on one and that a further eight are subject to ongoing active investigation.None have lost their registration yet.

15.02 Deputy GPC chair Dr Richard Vautrey says the Francis report should give GPs confidence to challenge bad care in hospitals. He told Pulse: ‘GPs already know they have an important role to play as patients’ advocates and if nothing else this report underlines the importance of that role and should strengthen us all to be bolder in how we stand up for patients, ensuring they receive the best possible care.’

‘This report should strengthen us all to be bolder in how we stand up for patients’

Deputy GPC chair Dr Richard Vautrey

14.53 Anna Dixon, director of policy at the King’s Fund thinktank, said even if the 290 recommendations in the report were implemented now, it would have no effect. She says: ‘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.’

13:46 Academy of Medical Royal Colleges says poor care ‘has the potential to happen anywhere’ and that they will be looking at what they can do.

‘The Academy and all individual Royal Colleges will be carefully examining the specific recommendations of the Francis Report to see how they, working with others, can take forward the necessary improvements to ensure that the circumstances in Mid Staffordshire cannot be repeated and we continually improve patient care.’


13.38 Petra Wilton, Director of Strategy and External Affairs at the Chartered Management Institute, points out that the report comes against a backdrop of figures showing that just one in five managers in the UK are professionally qualified. She says: ‘Nine out of 10 say management qualifications and training improves their performance and that of the teams they manage.’

13.36 Jeremy Taylor, chief executive of National Voices, said: ‘Patients and their families deserve a legal duty of candour, that’s a real duty to be honest with patients when things go wrong. It is disappointing that the Prime Minister didn’t commit to making this happen in his response to Francis’ recommendations today.’

‘A system obsessed with top-down targets leads to extreme pressure and a bullying culture’

BMA chair Dr Mark Porter

13.33 Dr Mark Porter, chair of the BMA said after reading the report: ‘Despite all the regulations and guidance to help staff raise concerns, a climate of fear, bullying and harassment can stop clinicians from speaking out.  

‘Unless and until medical staff and management jointly promote the ethos that raising concerns is not only acceptable but a positive thing, the shadow of Mid Staffs will put us all into darkness. Doctors, along with other clinical staff, have a professional responsibility to show leadership in helping to change this culture.  We must no longer accept the attitude that it is someone else’s job to worry about. 

‘A system obsessed with top-down targets leads to extreme pressure and a bullying culture, and there is a risk that basic clinical care is lost sight of in the race to meet deadlines.  There are other ways to raise performance levels including a focus on clinical leadership and partnership to help foster a system-wide approach.’


13.31 Chief Executive of Turning Point Lord Victor Adebowale said: ‘In taking forward Robert Francis’ recommendations, 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.’  

13.05 Sir Richard Thompson, president of the RCP, says: ‘Patient safety and quality improvement is a shared responsibility between healthcare professionals, managers and others working across the system. The RCP is committed to continuing our leadership role in ensuring doctors take responsibility for holistic care, not just diagnosis and treatment, and all care must be compassionate. Many of the Inquiry’s findings match those in Hospitals on the Edge? and we will incorporate the Inquiry’s recommendations into our Future Hospital Commission.’

12.48 Prime Minister David Cameron said that while the report found that the responsibility for the ‘appalling suffering’ lay mainly with the Trust board at Mid Staffordshire hospital it had also uncovered much wider systemic failures, including a cultural attitude that patient care was ‘always someone else’s problem’.

Speaking in the House of Commons, he said: ‘Too many doctors kept their heads down instead of speaking out [but the report] says we should not seek scapegoats.’

To the patients and families affected he said: ‘On behalf of the Government and our country, I am truly sorry.’

He said the Government will study all of the 290 recommendations in the report and respond next month.

‘GPs must be given the ability to do what is most important: listening to patients and caring for them’

RCGP chair Dr Clare Gerada

12.37 RCGP chair Professor Clare Gerada said the report showed that it was important to increase the number of GPs so they are able to focus on patient care. She says: ‘Clinicians, including GPs and their teams, must be given the ability to do what is most important: listening to patients and caring for them.’

12.02 Rick Stern, chief executive of the NHS Alliance says of the report: ‘We all have a duty to respond to the challenges of this report. Primary care has a crucial role in this. As the gateway to the NHS, general practice should be the first place that patients and communities go to make their voices heard, so it will be essential that GPs play the role of the ‘critical friend’, and ensure the patient voice is heard loud and clear, and the quality of local services remains high.’

11.58 Also calls for more funding for CCGs to allow them to hold NHS providers to account.

‘Commissioners should have powers of intervention where services are being provided which do not accord with their contracts. If fundamental standards are not being provided, the CQC, as regulator, should also be informed, and the commissioner and the CQC should in such cases
be able to act jointly or alone.’ Full report here

11.56 Francis report says GPs should have obligation to independently check quality of service provided at hospitals.

‘It will be important for the future that all GPs undertake a monitoring role on behalf of their patients who receive acute hospital and other specialist services. They have a role as an independent, professionally qualified check on the quality of service, in particular in relation to an assessment of outcomes. They need to have internal systems enabling them to be aware of patterns of concern, so that they do not merely treat each case on its individual merits.’ Full report here


11.11 Watch the Prime Minister’s response to the Francis report here from 12:30.

11.02 Gail Beer, Director at 2020health and former hospital director, says that having a chief inspector of hospitals will just ‘add another layer of bureaucracy’ instead of dealing with the root cause of the problems identified at Mid-Staffs. She says: ‘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.’




09.43 Lots of articles and blogs trailing the launch of the report out there this morning. predicts that David Cameron will announce ‘a major overhaul of the way the National Health Service is regulated’, while Isabel Hardman on the Spectator’s website says it is essential the Government’s response addresses the structure of NHS care as well as its culture.

Paul Corrigan, a former adviser to Tony Blair on the health service, tackles the politics of the report on his blog and argues that today is ‘an important day for the NHS to stick to its principles while learning from its mistakes’.

And from a grassroots GP’s perspective, Pulse’s very own Jobbing Doctor - writing on his own blog - offers an analogy with the Charge of the Light Brigade.

09.00 A word about timings today: the Francis Report is due to be published at 11.30am, with David Cameron due to respond on behalf of the Government at 12.30pm after Prime Minister’s Questions.

Tuesday 5 February 2013

17.45 As far as GPs are concerned, one of the major impacts of tomorrow’s report will be on their new commissioning role. Dr Jonathan Shapiro, a former GP and CCG leadership and development consultant, has previewed the report for our sister title Practical Commissioning, summarising what he believes the Francis report should - but probably won’t - say.

He writes:

Paul Batalden’s famous aphorism that ‘every system is perfectly designed to get the results it gets’ has become something of a cliché, but the NHS illustrates this truism over and over again. If Francis is to have any impact, it would do well to acknowledge some of the design issues that have led to the system delivering the services it currently does; perhaps by addressing just some of these, the cultural issues that drive any large iconic institution may begin to change. What is certain is that new regulations, however draconian, will only reinforce the current culture, and do nothing in the longer term to prevent further mid-Staffs type crises from happening.

Read Dr Shapiro’s piece in full here.

17.28 National Voices, the national coalition of health and social care charities, has put out a statement ahead of the report’s publication tomorrow warning of the dangers of an excessive focus on regulation.

Chief executive Jeremy Taylor said: ‘We hope that the Francis report will be the spur for a massive strengthening of patient and citizen voice in the health service. Health organisations need to be accountable for how well they listen and respond and local citizens need to be at the table when decisions are being made about services.’

‘We worry that the report will put too much emphasis on regulation. We think that is the wrong way to go. Not matter how good, regulators and inspectors cannot be everywhere at once. Patients, families and staff are the eyes and ears of the health service. We must ensure that they are in a position to speak out and be listened to.’

The charity published its own summary on ‘how to ensure safety and quality’ - entitled Not the Francis Report - back in October. You can read it in full here.

17.20 The Government’s official response to the Francis Inquiry report tomorrow will be delivered not by health secretary Jeremy Hunt, as would normally be the case, but by the Prime Minister David Cameron.

The Guardian reports:

The Prime Minister occasionally delivers the Government’s response to major inquiries, as he did on the Bloody Sunday inquiry and in the Pat Finucane case, when he believes it is important to acknowledge the gravity of the issue.

16.00 The Mid Staffordshire NHS Foundation Trust Public Inquiry’s report - or ‘Francis’, as it has become simply known in recent weeks - is expected to have a major impact on the NHS, with its impact felt in every corner of the health service.

The best part of three years in the making, the report published tomorrow examines the commissioning, supervisory and regulatory organisations which were supposed to be responsible for monitoring Mid Staffordshire NHS Foundation Trust between January 2005 and March 2009, during which there are thought to have been hundreds of patient deaths linked to substandard care.

The report will, as the inquiry’s website puts it, ‘consider why the serious problems at the trust were not identified and acted on sooner, and will identify important lessons to be learnt for the future of patient care’.