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NHS failed at every level, says Francis report

NHS failed at every level, says Francis report

NHS failed at every level, says Francis report

Clinicians, regulators and NHS culture have been criticised by the much awaited Francis report into the failings at Mid Staffordshire hospital, released today. 

The 1,781 page report claimed government targets on “financial issues”  had created a “ingrained culture with no thought for patient safety”. 

Robert Francis QC, who led the inquiry said there was an “appalling lack of care, compassion and leadership”. 

He said the evidence was “truly shocking” and many would find it “difficult to believe it all occurred in an NHS hospital”. 

“We must provide the standards of care to which patients are entitled,” he said. 

“We can't just blame one person for the failings or suggest reorganisation, we need a change in culture, a patient centred culture.” 

Francis called for a “structure of fundamental standards, openness, transparency and candour” throughout the healthcare system, improved compassion in nursing and stronger leadership. 

The report calls upon GPs to recognise a “duty of care” that extends beyond referral to hospitals, adding “they have a responsibility to all patients to keep themselves informed of the standards of care various providers in order to make patients' choice a reality.”

It said “there was a clearly ample opportunity for GPs to raise issues,” but that it was likely they did not, as the issues of which they had experience were not sufficiently significant and GPs were not required to act in this way. 

While the report stopped short of singling any one out for criticism, it did say it was “unfortunate” that it did not occur to GPs to report concerns. 

The report accused Monitor, the hospital regulator of “failing to achieve what should have been its primary objective”. 

It recommends that the Care Quality Commission (CQC) and Monitor should merge, but that it “should not be used as a justification for the reduction of resources”. 

It said nurses should be tested by a “minimum period of work experience” which should eventually be “reinforced by a system of revalidation”. 

There should also be specialist registered status for those nursing older people, according to the report.

Communication failures between Monitor and the Health Care Commission (HCC) may have come about because Monitor was “fiercely guarding its independence” at the expense of creating “good relationships.” 

The report was critical of  the management of primary care trusts (PCTs) reorganisation, which it said let to them missing “one of the worst examples of bad quality service delivery imaginable.” 

PCTs “failed to put into place systems and processes to manage risks,” the report said.

Clinical commissioning groups (CCGs) must work differently from PCTs to improve healthcare and should be allowed to carry out their own inspections, according to the report. 

There is an urgent “need” to rebalance and refocus commissioning so that it will “enhance standards” for patients, the report said. 

This will only work if commissioners are “recognisable public bodies” with an “infrastructure of technical support”, it said. 

Francis said that all organisations should report back on whether they have implemented his 290 recommendations. 


Nurses should not be the centre of blame but the standard of management.

The NHS is now a bottom up service which means the patient requirement is paramount. As a patient I would like all the largest Service Providers (as a start) to be required to have a professional quality management system. This would set the minimum level and improvements can go on from there. The system used internationally is the standard ISO9001:2008 for professional organisations. This is used by internal and external parties, including certification bodies and regulators, to assess an organisation's ability to meet customer, statutory and regulatory requirements applicable to the service, and the organisations own requirements. The standard is designed to enhance customer satisfaction by meeting customer requirements.

All Service Providers are currently required to make a statement of purpose on their aims and objectives in carrying on a regulated activity. To meet my concerns it would be a requirement through the Secretary of State for Health to insist that a quality management standard to ISO9001:2008 must be the key aim in any regulated activity commissioned to meet the essential standards in the NHS and quality of service to patients.

A professional quality management system will drive the economics and efficiency together with high standards in the NHS.

All patients using the NHS should be encouraged to request that a formal quality management standard is used in the hospital they attend. This hopefully would then be a normal requirement for all hospitals and services to the NHS.

D. White

My grandfather died in arrowe park hospital last night, the level of care he received was utterly disgraceful.
he was admitted for rehab following frequent falls . They failed to treat him for a UTi initially ,he developed a chest infection ,which led to pneumonia and he died 6days later .
he was so dehydrated they couldn't get blood off him after 6 days in hospital,he was NBM for over 9 hrs before they gave him iv fluids.he weighed 34 kg and 24 hrs before a salt assessment , the discharge team sent us a letter not dated re nursing homes on discharge the day he died, they told me when i rang to check how his condition was at 00.30 hrs -2hrs before he died asking if I should come in that he was sleeping soundly - I left him with a GCS of 3!
they failed to inform my parents of a change in his condition when he was dying so they could get in to be with him in the final hrs.they rang my parents at 0350 to tell them my grandfather had died when my mother stated she would come in but couldn't get in for about 11/2 hrs she was told too late he will have left the ward by then.
the staff nurse gave my parents the wrong advise re the bereavement office and so they waited in the car park in the rain for over 1hr for a death certificate, but the officer was at least kindly and apologised for the wrong information which is always given.
and to cap it all when we contacted an undertaker my poor grandpa has had to spend another night in that building because arrowe park don't release bodies at night.
im a nurse myself ,that level of care ,given to pts & relatives is beyond belief,it's appalling ,shameful and utterly neglectful, and it will keep happening because managers are not listening .

It saddens me as a nurse for more than thirty years, that the government/the NHS and the RCN did not see this coming. In my opinion the, the criteria for entering nurse training should be reviewed - we do not need a degree, we need a career pathway. I also believe that too many nurses from abroad are working in the NHS who do not have a good command of English, therefore communication is poor. Also some foreign nurses are not interested or do not grasp our culture, our culture for care. I have unfortunately experienced this myself recently as a patient for eleven days in my local teaching hospital.

MB Manchester

How dare you blame the RCN when this is what Peter Carter and the RCN has been saying that cuts in all areas of the NHS would lead to this kind of problems and it's people like yourselves who do not support and is ready to blame others ie saying that nurses from other cultures has no grasp on the English Language, and where is your understanding of Equality and Diversity, clearly you have now so hench this is why you have such a narrow view on what is really happening in the NHS.

HOW DARE YOU! people have a right to freedom of speech.It what our parents and grandparents founght for! I see you are too scared to put your name on it. The RCN have moved so far away from grass roots they do not know whatis important they are out to make themselves look good. and in fact it is the RCN and some of its policies that are making things difficult. Equality and Diversity does not work. it is ESSENTAIL that people UNDERSTAND each other (in language and cultural) especially when speaking to patients and relatives - if you can't speak English or Understand it then you should'nt be in a role where it is a crucial part of patient care. I don'tgive a damn whether this is politically correct, it has NO PLACE when caring for people.

It is incredible and frankly unbelievable on reading the Times report yesterday, that Dr Carter of RCN visited this failed hospital after receiving concerns from Nurses and failed to notice or pick up any evidence of failure.

I have been a member of the RCN for more years than I care to recall, and I am quite ashamed to be associated with such a supposedly caring and professional organisation, one that is supposed to protect and believe us until PROVEN otherwise.

They should all hang their heads in shame.

Yes you should hang your head in shame, simply because when Peter Carter was speaking about these problems you all did not support him and now this has happened you all are using a stick to beat him leave him alone because without him and the RCN things could or maybe worse.

So hard to improve staff training, as. a nurse manager I had staff with obvious issues, affecting patient safety, even linking with HR anything I tried backfired being accused of bullying , so stressful affected my own health.

I totally agree with you. To raise issues in the NHS takes far too long and it is very difficult to have people fired for poor performance. I am a student nurse about to qualify and I see issues every day not only with poor student but poor staff and mentors. Some of the students have no care for the patients they just sit and do paperwork, I know this is important but surely the patient should come first. Perhaps employing more ward clerical staff to help with the overwhelming paperwork and leaving the nurses to care would be an idea. Dont pass so many students when they obviously are not suitable is another.

Most days I phone a same ward at the local Hospital to be updated on specific patients returning to the comunity, I am a specialist nurse in orthopaedics. The amount of times I speak to the nurse who is looking after the patient who does not know what surgery they had performed, what antibiotic treatment they are on, what their PMH is, what the discharge plans are. Basic stuff but it beggers belief when they are the nurse in charge of that patient yet barely knows their name. How things have changed.

i am a PDN involved in nursing staff education and training and it so vital role in every department and area of practice.

There should be more stringent control into how nurses perform and it is extremely difficult to discipline nurses who are not safe.

I know how stressed i was for many months when i had to watch a senior sister who was so incompetent get away in many instances as she deemed everything as bullying and harrassment.

Finally she was suspended on a major drug error and even then it took over 2 years before she was finally sacked.

There must be definitely more robust system like school where not just mandatory study days are checked but also clinical education records and teaching records.

beautine wester
Barts health
Newham Hospital

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