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Blog Mary Agnew


Reflections on publication

Posted by: , Posted on: - Categories: Blog, Francis, NHS, Uncategorised

Today we published the full response to the Francis Inquiry -  Hard Truths - The Journey to Putting Patients First.

I am writing this in the early hours of the morning, feeling excited, tired and sick with nerves at the day ahead. The culmination of months of hard work for the team and many partners, launched under the fierce glare of a 24/7 media typically focused more on bad news than good, and a landmark day for the NHS. So no pressure then.

For all of us, it’s been an emotional journey. The stories in volume two of the first Inquiry report are unbearably harrowing and shocking. I, like many others, have wept reading them. Though I’ve tended to work on projects I care about in the past, it’s never been quite like this. The families are looking to the response to drive real and lasting change and to do justice to the Inquiry findings. I hope they feel it does this. We have certainly tried to. Yet the central paradox we face is that, above all else, the Inquiry is about the need for a fundamental culture change reaching into every part of the NHS, something that is hard – perhaps impossible – to drive or encourage from Whitehall.

I’m conscious too that many passionate advocates of the NHS – myself included – want a fair reflection of all that is already excellent about the NHS care, and unequivocal support for, rather than perceived criticism of, its hundreds of thousands of dedicated, courageous staff working day in day out to try to deliver the best in healthcare. It’s a difficult balance to strike – to respond robustly to the unacceptable and challenge the inadequate, whilst at the same time acknowledging the tremendous and celebrating the best. And a finely tuned balance liable to get lost in sound bite snippets, where the most eye-catching news of the day may not be the elements that will have the most lasting impact on the quality of care.

For me, the true test of the response is not about the news cycles of the next week or two, but rather whether people will look back in a year’s time, and again in five and ten years, and see it as having made a real difference. Has it tackled the ‘dark spots’ of poor care? Has it made a real and measurable difference to patient safety? Do patients report improved experiences of care? Is the NHS open with families when it makes causes harm? Does it listen to and learn from its staff? Do staff feel safe to speak up?

I won’t attempt to do justice to the full report here now, though will write more on its themes over coming days and weeks. In essence, it seeks to promote better leadership and an universal culture of candour and openness, with a renewed focus on patient safety, improved training and acting on complaints, underpinned by clearer, faster accountability for organisations and individuals where care is poor.

We are accepting the principles behind all of the recommendations of the Inquiry, which amounts to a broad and ambitious agenda for the NHS. For social care, some key implications are also set out. Throughout, we welcome and share the intentions behind the recommendations, though in some places the approach to implementation varies.

You can search for responses to particular themes or recommendation numbers here -

In each case, we have aimed to pull together a shared response from key organisations responsible for making change happen. All have reasserted their commitment to the statement of common purpose, including the values of the NHS as set out in the Constitution : working together for patients, respect and dignity, commitment to quality of care, compassion, improving lives, and everyone counts.

I hope you will read and discuss the report, and reflect on your own contribution towards improving safety, openness and compassion. NHS Change Day  is one way you can make a personal or collective pledge. So I’m signing off with hope and optimism about the changes afoot and the very many dedicated people across the NHS determined to make patient-centred safe care a reality everywhere.


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