The Francis report: key findings

 

The catastrophic failures started at the patients’ bedside but reached up, through the Byzantine hierarchy of the NHS, to heart of Government.

From the nurses who left patients in excrement-soiled bed clothes to the managers who only wanted ‘good’ news, to the Health Secretaries obsessed with financial targets, no-one emerges with credit from the Mid Staffordshire scandal.

Wards of Stafford Hospital

Francis paints a bleak picture of harassed, uncaring nursing staff who had lost the sight of their fundamental obligation to care. Nurses and healthcare assistants didn’t bother to help feeding patients who were unable to do so on their own, water was left out of reach while persistent requests for help were ignored.  Medicines were prescribed but not given, patients were discharged without being fit to go home, while those left behind were often left unwashed and unfed. “The most basic standards of care were not observed and fundamental rights to dignity were not respected,” he said.

Key recommendation: Nurses to be held personally and criminally accountable for the care that they provide to their patients.

Trust management

Francis describes the leadership of Stafford Hospital as being characterised by a lack of experience, great self-confidence, and an obsession with meeting Government-imposed targets without worrying about the consequences. There was a pervasive culture where poor practice was tolerated as long as it remained hidden. Even when high mortality figures and patient complaints were brought to their attention senior managers denied their significance. Instead all they cared about was balancing the books so they could achieve cherished ‘foundation trust’ status. Francis said: “It is impossible to avoid the conclusion that there was an unacceptable delay in addressing the issue of shortage of skilled nursing staff. There is no evidence of any sense of urgency about this problem”.

Key recommendation: Hospital boards should face dismissal if they fail to ensure minimum standards of safety and quality care.

Patient groups and MPs

Local patient groups should have acted as an early warning system to expose what was happening at Stafford much earlier. But the Public and Patient Involvement Forum at Stafford relied on uninformed and untrained volunteers. Francis says the patient representatives were beset by dysfunctional relationships and in-fighting. He also criticises local MPs who heard concerns about the Trust from constituents, but largely just passed these on to others without following them up.

Key recommendation: Patient groups should be properly funded with training given to members and the ability to carry out inspections of wards as well as the ability to bring in outside experts.

Primary Care Trust

This was the local NHS body which commissioned operations and care from Stafford Hospital on behalf of patients and should have been expected to have their interests at heart. It also represented local GPs who would have been well placed to raise concerns about poor care. But Francis says despite the PCT’s rhetoric about “aspirations to improve the quality of service” this meant almost nothing. Local GPs did not raise concerns about the hospital – even though they were aware of them – until specifically asked to do so following the announcement of an investigation. Francis pointedly recommends that GPs need to recognise their “continuing obligations to their patients” after referral to hospital.

Key recommendation: These bodies no longer exist and have been replaced by GP led commissioning groups. Francis says these groups should monitor all hospitals where they send their patients including carrying out professionally qualified checks on the quality of service offered as well monitoring outcomes.

Strategic Health Authority

This body, led at the time by the now head of the NHS Sir David Nicholson, should have been responsible for making sure Stafford Hospital was well run and safe for patients. But Francis accuses the SHA of making no link between its financial role and how this could impact on patient care. Dammingly, the report says the SHA saw its role as defending the trust against the Healthcare Commission (the body charged with maintaining clinical standards) rather than holding it to account. 

Key recommendation: These bodies no longer exist but Francis makes clear that there must no longer be any distinction between bodies ensuring the financial viability of a hospital and those ensuring good patient care.

Healthcare Commission and Care Quality Commission

During the period of the Stafford Hospital scandal these two bodies were responsible for assessing and reporting on standards of patient care across the NHS. Francis says the Healthcare Commission did not have the money to run a proper complaints unit and relied far too much on hospital self-assessment in making it findings. When the CQC took over these responsibilities it initially lacked the resources to carry out the responsibilities it has been given in statute. It did not carry out enough inspections while Francis criticises an “unhealthy culture”, in which senior managers were more concerned about their public image than “delivery”.

Key recommendation: A specialist cadre of hospital inspectors should be created with the involvement of patients to identify problems early.

Department of Health

Francis says while the Department was not culpable of any direct responsibility for the failing in Stafford the evidence he saw revealed a “remoteness” from the reality of front-line staff and patient experience. He said that its directives to hospitals and emphasis of policy implementation had sometimes been perceived as “bullying or applied oppressively”.

Key recommendation: No more top-down re-organisations of the NHS. At all times there should be senior clinical involvement in policy decisions and all staff must spend time on the frontline as well as meeting those who have suffered bad experiences.

PROMOTED VIDEO
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
Arts and Entertainment
glastonbury
News
i100
Arts and Entertainment
Shock of the news: Jake Gyllenhaal in ‘Nightcrawler’
filmReview: Gyllenhaal, in one of his finest performances, is funny, engaging and sinister all at once
Arts and Entertainment
Shelley Duvall stars in Stanley Kubrick's The Shining
filmCritic Kaleem Aftab picks his favourites for Halloween
News
people
Arts and Entertainment
Kit Harington has been given a huge pay rise to extend his contract as Jon Snow in Game of Thrones
tv
Life and Style
Taste the difference: Nell Frizzell tucks into a fry-up in Jesse's cafe in east London
food + drinkHow a bike accident left one woman living in a distorted world in which spices smell of old socks and muesli tastes like pork fat
Sport
Luke Shaw’s performance in the derby will be key to how his Manchester United side get on
footballBeating City is vital part of life at United. This is first major test for Shaw, Di Maria and Falcao – it’s not a game to lose
Life and Style
Google's doodle celebrating Halloween 2014
tech
Arts and Entertainment
Don’t send in the clowns: masks and make-up conceal true facial expressions, thwarting our instinct to read people’s minds through their faces, as seen in ‘It’
filmThis Halloween, we ask what makes Ouija boards, demon dolls, and evil clowns so frightening?
News
peopleFarage challenges 'liberally biased' comedians to 'call him a narcissist'
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Senior IP Opportunity at Major Firm

    vary Attractive Salary: Austen Lloyd: MANCHESTER - AN OPENING AT A VERY HIGH Q...

    Nursery Manager

    £100 - £110 per day: Randstad Education Ilford: Nursery Manager Long term Ran...

    Sales Consultant – Permanent – West Sussex – £24-£25k plus commission and other benefits

    £24000 - £25000 Per Annum plus company car and commission: Clearwater People S...

    SEN Teaching Assistant

    £45 - £65 per day: Randstad Education Bristol: Supply SEN Support Jobs in Bris...

    Day In a Page

    The drugs revolution starts now as MPs agree its high time for change

    The drugs revolution starts now as MPs agree its high time for change

    Commons debate highlights growing cross-party consensus on softening UK drugs legislation, unchanged for 43 years
    The camera is turned on tabloid editors in Richard Peppiatt's 'One Rogue Reporter'

    Gotcha! The camera is turned on tabloid editors

    Hugh Grant says Richard Peppiatt's 'One Rogue Reporter' documentary will highlight issues raised by Leveson
    Fall of the Berlin Wall: It was thanks to Mikhail Gorbachev that this symbol of division fell

    Fall of the Berlin Wall

    It was thanks to Gorbachev that this symbol of division fell
    Halloween 2014: What makes Ouija boards, demon dolls, and evil clowns so frightening?

    What makes ouija boards and demon dolls scary?

    Ouija boards, demon dolls, evil children and clowns are all classic tropes of horror, and this year’s Halloween releases feature them all. What makes them so frightening, decade after decade?
    A safari in modern Britain: Rose Rouse reveals how her four-year tour of Harlesden taught her as much about the UK as it did about NW10

    Rose Rouse's safari in modern Britain

    Rouse decided to walk and talk with as many different people as possible in her neighbourhood of Harlesden and her experiences have been published in a new book
    Welcome to my world of no smell and odd tastes: How a bike accident left one woman living with unwanted food mash-ups

    'My world of no smell and odd tastes'

    A head injury from a bicycle accident had the surprising effect of robbing Nell Frizzell of two of her senses

    Matt Parker is proud of his square roots

    The "stand-up mathematician" is using comedy nights to preach maths to big audiences
    Paul Scholes column: Beating Manchester City is vital part of life at Manchester United. This is first major test for Luke Shaw, Angel Di Maria and Radamel Falcao – it’s not a game to lose

    Paul Scholes column

    Beating City is vital part of life at United. This is first major test for Shaw, Di Maria and Falcao – it’s not a game to lose
    Frank Warren: Call me an old git, but I just can't see that there's a place for women’s boxing

    Frank Warren column

    Call me an old git, but I just can't see that there's a place for women’s boxing
    Adrian Heath interview: Former Everton striker prepares his Orlando City side for the MLS - and having Kaka in the dressing room

    Adrian Heath's American dream...

    Former Everton striker prepares his Orlando City side for the MLS - and having Kaka in the dressing room
    Simon Hart: Manchester City will rise again but they need to change their attitude

    Manchester City will rise again but they need to change their attitude

    Manuel Pellegrini’s side are too good to fail and derby allows them to start again, says Simon Hart
    Isis in Syria: A general reveals the lack of communication with the US - and his country's awkward relationship with their allies-by-default

    A Syrian general speaks

    A senior officer of Bashar al-Assad’s regime talks to Robert Fisk about his army’s brutal struggle with Isis, in a dirty war whose challenges include widespread atrocities
    ‘A bit of a shock...’ Cambridge economist with Glasgow roots becomes Zambia’s acting President

    ‘A bit of a shock...’ Economist with Glasgow roots becomes Zambia’s acting President

    Guy Scott's predecessor, Michael Sata, died in a London hospital this week after a lengthy illness
    Fall of the Berlin Wall: History catches up with Erich Honecker - the East German leader who praised the Iron Curtain and claimed it prevented a Third World War

    Fall of the Berlin Wall

    History catches up with Erich Honecker - the East German leader who praised the Iron Curtain and claimed it prevented a Third World War
    How to turn your mobile phone into easy money

    Turn your mobile phone into easy money

    There are 90 million unused mobiles in the UK, which would be worth £7bn if we cashed them in, says David Crookes