Reaction: Francis report

NHS bodies and medical institutions have responded to the Francis report into failings of care at Mid Staffordshire NHS Foundation Trust.

RCGP

RCGP chairwoman Professor Clare Gerada said: 'What happened at Mid Staffordshire NHS Foundation Trust was system failure of the highest order and we are deeply saddened that so many patients and their families were let down, with such tragic results. Unfortunately, it demonstrates the extreme consequences of what can happen when the NHS loses sight of patient care on the ground in the scramble to balance budgets and achieve targets.

'While the Francis report focuses on failings in secondary care, it has implications for the whole of the NHS, including general practice. At a time when the NHS is under greater than ever financial pressure, it is imperative that the needs of patients are put first, and that cuts are not made which could jeopardise the safety of patient care.'

Professor Gerada added: 'GPs have so far ridden the storm but financial constraints and top-down targets are starting to adversely affect the level of care we can deliver to our patients. We need to reverse this trend by increasing the number of GPs available to provide patient care, and by ensuring they are free to focus their attention on what matters most to patients.

'The NHS was set up 65 years ago to provide fair and effective healthcare and to protect patients. If it is to continue doing this, the Government and all of us working in the NHS must stop underestimating the importance of kindness and compassion, the fundamentals of good patient care that cannot be budgeted for.'

BMA

BMA chair of council Dr Mark Porter said: 'I have been profoundly disturbed and saddened to hear again how a series of failures at Mid Staffordshire NHS Trust resulted in such tragedy for so many patients and their families.  The accounts of appalling and unnecessary suffering are truly shocking.

'It is not enough to say that lessons must be learnt.  It is essential that we all - politicians, NHS organisations, doctors, managers, nurses, and patient groups - work together to develop a different kind of health service where the system will not tolerate poor quality of care.

'We must urgently develop a new culture - everyone working in the health service must play their part, and be allowed to play their part, in practising zero tolerance to poor and dangerous care.'

He added: 'A system obsessed with top-down targets leads to extreme pressure and a bullying culture, and there is a risk that basic clinical care is lost sight of in the race to meet deadlines.  There are other ways to raise performance levels including a focus on clinical leadership and partnership to help foster a system-wide approach.'

NHS Alliance

Rick Stern, chief executive of the NHS Alliance, said: 'Like everybody involved in healthcare, we are shocked at the events at Mid Staffordshire hospital, as outlined in the Francis report. There was clearly a failure in systems, and there had been a focus on the institution and processes, instead of the patient population.

'It may be tempting to call for more rules and stronger regulation to ensure that this never happens again. But at the heart of the failure at Mid Staffordshire was a culture where people felt unable or unwilling to challenge what was going on, and to ensure that caring for people and making sure that they are safe is always placed above finances. There will need to be a cultural change, with a new emphasis on the power of the patient voice.

'At the same time, all of us working within the NHS will need to take responsibility, encouraging clinicians and managers to speak out when care is just not good enough. We all have a duty to respond to the challenges of this report.

'Primary care has a crucial role in this. As the gateway to the NHS, general practice should be the first place that patients and communities go to make their voices heard, so it will be essential that GPs play the role of the ‘critical friend’, and ensure the patient voice is heard loud and clear, and the quality of local services remains high.'

NHS Clinical Commissioners

A spokesman for the NHS Clinical Commissioners' leadership group said: 'The detailed and serious report produced by Robert Francis QC makes uncomfortable reading for anybody who works in the NHS. It is clear that there is a collective responsibility to ensure that failures such as happened at Mid Staffordshire NHS Trust do not happen again.

'As the leaders within CCGs we recognise that quality is the personal responsibility of all who work in the NHS and we cannot delegate that responsibility to anybody else. We will use the levers available to CCGs through the commissioning process, clinical engagement and public involvement to drive up quality. We will also use our relationship through that process with providers to ensure and be assured about quality and outcomes. We will also explore and address unwarranted variation.'

It added: 'Engagement of those at the front line of general practice is central so CCGs can genuinely be a collective voice for all primary care professionals; CCGs must engage with their members to ensure knowledge of patients experience held in local primary care is shared to improve quality for all.'

Royal College of Physicians

Sir Richard Thompson, president of the Royal College of Physicians, said: ‘Patient safety and quality improvement is a shared responsibility between healthcare professionals, managers and others working across the system. The RCP is committed to continuing our leadership role in ensuring doctors take responsibility for holistic care, not just diagnosis and treatment, and all care must be compassionate.

'Many of the inquiry’s findings match those in Hospitals on the Edge? and we will incorporate the inquiry’s recommendations into our Future Hospital Commission.’

NHS Confederation

Mike Farrar, chief executive of the NHS Confederation, said  'This is a hard-hitting but fair analysis of what happened in Mid Staffordshire and that is exactly what we needed. Crucially, Mr Francis has offered us a forensic ward-to-Whitehall assessment of one of the biggest failings in the NHS.

'He has set out proposals for getting the whole system behind one core objective: putting patients at the centre of the NHS. That objective is something that we should all applaud. Everyone in the NHS must now consider these recommendations and find ways of acting on them.'

Mr Farrar added: 'It is right that the government now takes time to consider the report's recommendations. We will be working closely with our members to indentify effective solutions to the problems we face. I strongly believe the Government should work with our members - and indeed all patient and staff groups - to find the right way forward.'

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