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Blog Mary Agnew


One year on

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On this first anniversary of publication, it seems no exaggeration to describe the impact of The Mid Staffordshire NHS Foundation Trust Public Inquiry as seismic. Indeed, it seems hard to believe it was only a year ago we were all sat reading the report – the whole tenor and breadth of the debate on quality, compassion, safety and openness has changed in response. At the time, there was some anxiety that other organisations across health and care might be dismissive of the findings, viewing the devastating failures of care at Mid Staffs as a unique aberration that ‘could never happen here’. In fact, the response has typically been the opposite – a mature, reflective self-scrutiny in which organisations have recognised that dark spots can exist in otherwise excellent organisations and that there is always more to learn and improve to deliver safer, more compassionate patient-centred care.


In my time on placements this year – across mental health, community and acute trusts – I’ve been impressed time and time again by how NHS staff have reflected on the meaning of the Inquiry for their own professional practice, team working and their organisation’s culture and values. Through our new Connecting programme, I’ve been privileged to be immersed in different aspects of NHS work and to talk in depth to staff about the amazing and difficult jobs they do. Of course many civil servants went on visits pre-Francis, but having a structured programme of this scale across the whole organisation gives us far more meaningful insights. If your organisation would like to become a Connecting partner, do get in touch.


Research published today by the Nuffield Trust confirms this sense of how seriously trusts have responded to the Inquiry, drawing on in-depth interviews with around 50 staff at five acute hospital trusts and an online survey of chairs and chief executives. Four in five of the hospitals responding to the online survey said they were taking new action in response to the report, and more than 90% said they already had work underway on many of the relevant recommendations when the report was published.


The report also highlights the challenges facing organisations improving quality in a difficult financial context amid a complex system. It's a very demanding leadership challenge, and it has been really impressive how so many organisations have risen to it so whole-heartedly. Of course, poor care is hugely costly. A large part of meeting the Francis challenge is about doing things in the right way, in the right spirit, listening and learning from patients and frontline staff. No-one can afford not to.

Of course, there’s a huge amount of ongoing action at a national policy level, and the  Government response sets out ways forward on all 290 recommendations. Some ways you can get involved:

  • The Department is currently consulting on regulations to take forward Robert Francis’ recommendations on Fundamental Standards  - the clear, unequivocal basics of care that every patient had a right to expect, with consequences for any organisation breaching these.
  • The Government has asked Professor Norman Williams (President of the Royal College of Surgeons) and Sir David Dalton (Chief Executive of Salford Royal Foundation Trust) to provide advice on what the threshold for the duty of candour should be.  You can find out more about the review here and email the secretariat at
  • You can support the work of enhanced Care Quality Commission inspections by telling them about your own experiences of care and the improvements needed at a listening event.


So priorities for 2014? For me, it’s putting real momentum behind the patient safety agenda – more to follow in a future blog – and a concerted focus on staff engagement. Staff engagement is clunky management speak for the obvious, but often neglected, truth that if staff are treated well and able to make decisions, care will improve. It’s about unleashing that intrinsic motivation and passion that leads people to a career in healthcare in the first place. A new resource from The Point of Care Foundation summarises the substantial evidence base about how staff care improves patient care, and examples of good practice.  There is also a wealth of resources and support available from NHS Employers.


In presenting his report a year ago, Robert Francis QC, stated:


“My recommendations represent not the end but the beginning of a journey towards a healthier culture in the NHS in which good practice in one place is not considered to be a reason for ignoring poor practice somewhere else; where personal responsibility is not thought to be satisfied by a belief that someone else is taking care of it; where protecting and serving patients is the conscious purpose of everything everyone thinks about day in day out.”


The journey has certainly begun, but there’s a lot further to go. You can add your own personal pledge at NHS Change Day and email the team at to share what your organisation has done and your reflections on the next stage of the journey.


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