Initial thoughts on the Francis Report

11th February 2013 11:38 a.m.

Richard Diment

So we now have the Francis Report. There is no doubt that it will have a profound impact on the NHS for many years to come. As the Guardian’s immediate on-line coverage headlined – ‘Francis shows NHS is not the national treasure we thought it was’.

Highly critical of almost every organisation that has a role in the direction or regulation of the NHS, Francis concludes that Mid-Staffs was unlikely to be a one-off. It can’t be a co-incidence that the Prime Minister has already asked the Medical Director of the NHS to conduct a review of the performance of five Trusts with, at least prima facie, mortality statistics that need detailed investigation. There is widespread speculation that others will also be looked at.

I confess that I haven’t read the full report – that runs to three volumes and almost 1800 pages – but I’ve skimmed through the 116 page Executive Summary. Francis has identified failings in almost all parts of the NHS and the Department of Health. He has made no fewer than 290 recommendations for change. Clearly some of those cannot affect Oxleas directly, e.g. the process for achieving Foundation Trust status, but many will affect not just Oxleas but every other part of the NHS.

I remember working with the National Patient Safety Agency about 10 years ago to improve the reporting of adverse incidents and create a no-blame culture but obviously that wasn’t enough. This morning’s headlines are about creating new offences under which doctors, nurses and NHS managers who conceal mistakes would face prosecution but there’s an awful lot more. Another proposal is to merge the two regulators CQC and Monitor.  It’s clear that one of the problems about Mid-Staffs is that they didn’t share information. I’ve never really understood why the two separate bodies were needed in the first place. If the argument was to create a double check, it’s now clear that any benefits from separating their functions were outweighed by a lack of communication and key checks falling into the gap between them. Combining their functions would make a lot of sense particularly as the NHS moves towards its goal of Trusts achieving Foundation Status. But there are questions about what Regulators can do. David Prior, the new Chairman of the CQC, is quoted in the papers this morning as saying that the CQC ‘cannot give a guarantee’ that another Mid-Staffs would be spotted by regulators.

Governors come in for attention in a several parts of the report. Francis asks serious questions about how effective we are. I think Oxleas has a strong Council of Governors but Francis suggests that in some FTs the Governors are little more than a League of Friends. He highlights the need to enhance our role through better training and resourcing as well as checks to ensure that we are competent and properly fulfilling our duties. Francis makes the point that evidence he was given by the CQC revealed that only 12% of the expressions of concern about NHS services received come from Governors. He thinks that number is too low. I’m not sure. He proposes that, on appointment, each of us should be contacted directly by the CQC to explain our responsibilities and tell us how to raise any concerns directly with the Commission. 

This also raises questions about the time commitment that Governors can make particularly if they have livings to make or caring responsibilities. He also raises the concern I’ve expressed before about the legitimacy of our mandate and how can we effectively engage not just with the constituencies we represent but with the wider community.

Ministers cannot park this report. One of Francis’s recommendations is for the Government to report back regularly on progress with implementation. I’m sure I read or heard somewhere that the Government has 30 days to make a formal response. If yesterday’s statement from the Prime Minister is to be seen as more than rhetoric, that response needs to set out a very robust plan of action.

Filed under: Members and governors

Richard Diment


Richard Diment was elected as a Public Governor from Bexley in September 2012. He will make occasional contributions to the blog about his activities at Oxleas and other developments which may impact on the trust.

Richard has lived in Bexley for 27 years and has been a member of the trust since 2006. He has had a career in public affairs working across a range of sectors including construction, transport and health during which time he worked with a wide range of organisations including government, public bodies, PLCs and micro-businesses.

For seven years he was Chief Executive of the national association for NHS Ambulance Trusts where he first became involved in work around mental health and disability issues. In the past he has been Chairman of Governors at Old Bexley Primary School and he is currently a Board Member at the Bexley Mooring Project, the local charity supporting vulnerable young people.

Richard's blogs reflect his own opinions and not the Council of Governors as a whole.


At the Heart of Mid Staffs was the push to implement a key part of government strategy in an area of the NHS that just was not equipped or resourced to become a Trust. tinkering with nurse training and the registration HCA's does not deminish the fact. That Managers at the most senior level of the Trust were focused on implementing government policy. This was the starting point of the culture at Mid staffs, nothing was allowed to get of implementing Government policy

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