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Francis report: Cameron needs to talk about the structure of NHS care as well as the culture

6 February 2013

The Francis Report into Mid Staffordshire hospital trust will be published at 11.30am today. David Cameron will make a Commons statement this afternoon on the matter.

Yesterday I explained why Cameron should be bold today and go beyond the usual ‘lessons must be learned, procedures should be tightened’ platitudes. One of the greatest risks is that the government ends up introducing more targets and more bureaucracy with simply replace or even add to burden created by Labour which the Report will criticise today.

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But as Iain Martin points out, the Mid-Staffs failure took place following huge increases in NHS spending. This isn’t a death-by-cuts story. Targets and a lack of scrutiny might be one problem, but now is also the time to stop being squeamish about systemic reforms which will tackle complacency in the NHS. The Health service still operates with a blitz-style be-thankful-for-what-you-get spirit when, as our leading article argued, independent providers do not have that luxury. Cameron wants to talk about the culture of care today, but will he talk about the structure of care as well?

It would be much easier to avoid these bigger issues and simply appoint new chief inspectors and set out new duties to report poor care. Those will help tighten procedures. But now, as Labour finds itself having to keep quiet for a little while at least about being the ‘party of the NHS’, is the time to talk about the big lessons that need learning about public and private providers, too.

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Show comments
  • El Capitan

    The report didn’t have to take so long nor cost so much. Why not earlier?

    Francis doesn’t even begin to tell us how we can get a better managerial culture in British hospitals. He’s a lawyer for god’s sake! The wily old William Hopper just called the report “a half-eaten meal sitting by a semi-conscious patient.” Or something like that.

    It’s here:

  • Gerry Boy

    If I were cameron I would keep off NHS structures.

  • Andrew

    Where’s Telemacus (aka Balls’ PA) when we most need him. By the way, has anyone else noticed how he only posts on weekdays. No such thing as weekend work for the ‘workers’.

    • starfish

      I think even he can’t spin this one

  • don logan

    Andy Burnham’s gone a bit quiet hasn’t he….

    • realfish

      Keeping his head down!

      It’s interesting to look back at the reports of this joker’s evidence to the Inquiry. This was the man who recommended Stafford for Foundation Status, on the basis of only 4 lines of evidence. Burnham failed to ask questions that he should have done and worse, when he says, “I remain very puzzled why at local level there wasn’t ‘noise’ about this trust.” he effectively blames the patients and their families for not speaking up. This was a lie, they did speak up and paid the price for doing so.

      This buck stops with Burnham. He must resign. Miliband also needs to explain why he judged it appropriate to appoint Burnham to the Shadow health post when under such a cloud

  • Bob Dixon

    Cameron is a dead man walking.There is no reason why we should believe in anything he says.

    • realfish

      Actually, in Parliament today, Cameron looked every bit a Prime Minister. Miliband, in his response to Cameron’s statement, looked anything but.

  • Magnolia

    I have set out on these pages and those of the DT, time after time after time, how the education, training and working practises of doctors changed over the course of the last Labour government.
    I believe that these changes are at the root of many of the problems of the NHS in the same way that changes to nursing training have affected nursing care.
    At the heart of the problem is the de-professionalisation of Nursing and Medicine which has resulted from political demands.
    To put it simply, when you consult a doctor now, they are working within the constraints of their politically changed education and training, their politically constrained instruction on working practises and their politically minded rationing role.
    In the past the patient went to the doctor whose job was to carry out a satisfactory medical history and examination to the best of their ability and to make a diagnosis upon which further tests and/or treatment were arranged. There was also a duty of following the disease progression which aids diagnosis and that’s called continuity of care. Part of the professional duty was also to refer to other specialists in an appropriate way and the good practice of Medicine also depended on the effective functioning of lab staff, nursing care, cleaners etc.
    In the modern NHS most of these basic functions of Medicine are no longer apparent.

  • Charles Hedges

    Imprison Sir David Nicholson.

  • toco10

    Blair,Brown,Miliband et al and their dysfunctional and class ridden Labour Government as usual let the Country down on all the major issues.The Economy,the NHS and Foreign Affairs given Iraq and Afghanistan.It would the utmost folly to trust them again.Looking at the current lot which includes Red Ed and Ed Balls both directly responsible for the financial mess we are in the thought of either of them being allowed any power again is scary indeed.

    • huktra

      I fear you are correct but how does that get us to the big picture and the need to redress what has gone before?

  • Colonel Mustard

    Will Labour get their just desserts from this? Probably not. When it comes to accountability they are teflon coated and will no doubt find ways, endorsed by their partners in crime the BBC, to blame all this on the Coalition – well on the Tories at least. The betting is that most of the spokespeople on TV today will be from Labour – or their fellow travellers – and will duck and dive, dodge and weave, distance themselves from cause and effect, distance themselves from New Labour (even though they were dead central to New Labour), perhaps even claim that the Mid Staffs crisis started in America.

    And will Cameron and Co use this criminal scandal as a deadly political weapon to skewer Labour and keep on skewering? Probably not. Because he and they are cowardly wets who empathise with the ideologies of the revanchist left and who don’t have the first clue about what it means to fight the enemy according to his own methods.

    The political edifice is rotten to the core. Full of weak, dissembling cowards and con men, chancers and criminals. If our “statesmen” are prepared to lie to the point of prosecution to escape points on their driving licences what hope of any honesty in politics? The real culprits for all this were not in Mid Staffs but in Westminster.

    • James Strong

      What happened in the Stafford hospital is a disgrace.
      But you have predicted bias in BBC reporting.
      I am thoroughly fed up with this; commenters reinforcing each other saying the BBC biases its reports, but I never see any bare facts to support this.
      If you can produce evidence of it then I’ll be very pleased to see it.
      So, how about producing analyses of : spokesmen, time allocated, what each spokesman says and who they blame for this appalling series of events in the hospital. Please add in what the reporter says by way of his introduction and explanation of the story.
      Then we can see if your predictions are proved to be accurate, and if they are your case will be much stronger.
      My own view on the NHS problems is that we should abolish the NHS.

      • Colonel Mustard

        Evidence of BBC bias? Do bears crap in the woods? Common knowledge and there are whole websites dedicated to it. Instead of inviting me to waste my time providing evidence of something every man and his dog in Britain already knows (and which even the BBC have admitted) google it yourself and fill your boots.

        • James Strong

          I’ve been on Biased BBC and what I repeatedly find is posts by people who are themselves biased stating that the BBC has reported news items in a way different from the way they would have done it.
          The burden of proof is on you, not me. I’m sure you know that, even if you are not aware of the details of the debating trick you are trying to pull by reversing the burden of proof.
          I say again: spokesmen, timings, quotes.
          If you can provide that evidence I am ready to accept what you say; if you can’t find that evidence then your statements don’t have much value.
          You predicted BBC bias in reporting the Stafford Hospital disgrace.
          Please show it.
          ‘Common knowledge’ and ‘every man and his dog’ is not evidence, just as ‘data’ is not the plural of anecdote’.
          I suspect that what happens is someone like you comes on and makes the assertion, someone like Russell agrees with it and you that’s enough for you.
          It’s not good enough when discussing something important.
          You made a specific prediction, prove that it was an accurate one.

          • 2trueblue

            Watch channel 83 for clarity.

      • 2trueblue

        You need to change your medication. It is interfering with your perception of the facts.

  • Russell

    Here again the public will be given evidence that the NHS patients are not safe in Labour hands, but will the IQ2’s get it? probably not, by the time the BBC and usual suspects in this paper and the rest of the media do their spin campaign.

    • huktra

      This is not political.
      It is about standards and how to rekindle professionalism in a demoralised workforce.
      That is ultimately about the quality of local management and leadership.

      • Russell

        It could not be more political. Watch the tv and on most days Burnham & Co. are pushing ‘the NHS is not safe in tory hands’ line whilst in total denial about the fact that PATIENTS weren’t safe when the NHS was in Labour hands. Up to 1200 unnecessary deaths (DEATHS) due to mismanagement and lack of care from hospital staff, all in a system designed by Labour and operated under labour between the years 2005 and 2008.
        Imagine for a minute it was your mum or dad who died due to labours target driven NHS system. The structure and operating systems of the NHS are most definitely political.

        • huktra

          I sense that the points being made are that this is the opportunity to drag the issue away from politics left and right. Now is the time to motivate and lead.

      • Smithersjones2013

        This is also about bringing to account the idle, smug, self-serving incompetent bureaucrats, politicians and senior medical staff who are responsible for so many deaths on their watch. Not just one or two but ALL of them and ensuring they never can sully the NHS again or the wider care industry in anyway whatsoever with their disgraceful behaviour and where appropriate criminal charges of negligence and manslaughter should be brought!

        The Stafford tragedy really does demonstrate just how much ‘They Loved The NHS’. First and foremost that idiot Burnham should be sacked as Shadow Health Secretary for his shocking incompetence and stupidity.

        Its time Government stopped protecting the dysfunctional parts of the public sector from full accountability. They’ve gone after the police for what in comparison is far less (lives were not at stake).

        • huktra

          I think you have it.
          There was an era of the medical superintendent.
          The medical manager driven by professional standards.
          If this debacle leads to some such then all has not been in vain.

    • James Strong

      See above. I’d like to see dispassionate evidence of BBC bias in the way they report this.

      • Russell

        Google BBC bias for yourself.

      • 2trueblue

        Why don’t you listen to what the BBC actually say, and which ‘rent a mouths’ they hire on the day?

  • huktra

    It is a question of how you motivate and value staff

    • Russell

      It is more a question of how competent managers, doctors and nurses are at caring out their responsibilities of care.

    • starfish



      not sure the current crop of politicians understand that

      • huktra

        Precisely and why?
        Because all parties see the NHS as. Convenient stick to beat the opposition.

      • Common Purpose

        Yes motivate and then nurture these leaders. We need to give them the confi- dence they need to legitimize themselves and challenge the old ways. And we need to make them successful as they create new ones. Why do so many leaders in this situation withdraw to their home territory, bruised, muttering about “them” as they retreat? Because they simply do not know how to lead people who are not “theirs.” They do not know how to adapt when the instincts that led them to success in their own field do not work outside it.
        The NHS is par excellence an extension of our wider community and we need to lead within and without.

    • Smithersjones2013

      No its a question of ending the culture of nepotism by ‘like-minded’ bureaucrats and politicians and returning to common sense and good management.

      • huktra

        And leadership.
        And vision.

      • starfish

        won’t happen

        politicians love to meddle, especially when they are ignorant

        select and empower leaders, give them clear direction and a strategic vision and see things change

  • lee taylor

    Labour are still out spinning their targets today and judging by the BBC coverage it looks like they’ll get away with it as usual.

    • huktra

      If you heard Nigel Crisp on Today he gave a balanced non political judgement which is how it should be.

      • Russell

        Spinning now onto full speed with Sky news reporting that a ‘poll’ of nurses say that another Staffoed could happen today due to staffing levels being too low!!!!!!More fatties needed to sit in front of computers filling out tick boxes on how they are performing instead of actually washing, feeding and caring for patients, unbelievable, and the dross who vote for labour will suck it all up as the fault of tory cuts as spouted by Burnham & Johnson, the two prime candidates for imprisonment for their incompetence whilst Ministers of Health during labours years in office.

        • huktra

          You are wrong.
          We are all to blame.
          We have been supine.
          We have all been patients or observed relatives as patients and have observerved substandard care and what have we done?

          • 2trueblue

            I think you will find that the families of those in Stafford did complain. Their relatives still died.

        • 2trueblue

          Perhaps if the nurses who feel so strongly on this matter could attend to patients rather than chatting with each other at the nurses station. And no, they are not discussing the patients.

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