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The Francis report: One year on


A year on from the Mid Staffs inquiry, NHS Employer CEO Dean Royles reports on the progress that has been made to NHS staff culture

This week marks one year since Robert Francis published his long-awaited review into Mid Staffordshire Hospitals. It feels like an historic week.

At NHS Employers a year ago today, we gathered round the television to listen to Robert Francis delivering his report. Not quite a ‘Where were you when Kennedy was shot?’ moment. But for those of us in the NHS, pretty close.

Although much of the background to what happened in Mid Staffs was known (following the previous review) it was still shocking and I think took some time to assimilate. For many, the fact that a lawyer – a lawyer! – had drawn attention to poor care was too much to tolerate... The message got home.

And a year on, what has changed on the workforce front?

A stronger culture

A number of commentators are reporting palpable improvements in organisational culture. This didn’t happen by chance. It will have involved the intentional actions of managers and leaders on the ground. That deserves our praise.

In addition, it’s clear that staffing levels and safe staffing have risen up the agenda. I don’t mean that this wasn’t an issue before, but that there is growing scrutiny from the board to the ward.

However, there are still issues about the robustness of tools and reporting mechanisms and an undue focus, in the media at least, on nurse staffing levels and ratios.

I hope that the NICE-commissioned tools, as recommended by Francis, will provide more robust multi-disciplinary modeling. 

It would be a new tragedy if we grew nursing on the ward at the expense of nursing in the community, or the expense of staff like physios, OTs, technicians, scientists and support staff.

Raised awareness of whistleblowing

There is also increased awareness of whistleblowing, not just as an appreciation of high profile national scandals, but what that means locally in individual organisations and whether the culture is one that supports and encourages staff to raise concerns.

The debate around this is double edged. The publicity from raising the profile and encouraging trusts to examine policy, practice and culture may, I think, also have led to some confusion between raising concerns internally and then blowing the whistle externally, when no action has been taken or is perceived to not be taken.

So a shibboleth has developed. “If you raise concerns you lose your job”.

This is far from the truth – we know staff have already felt able to raise issues eg. 90% know how to raise concerns and 10% (that’s 10% too many) don’t feel safe to raise them.

We have to get the language and the analysis right on this one. The consequences of confusion are significant. And we need to address those places in organisations where bullying is having a corrosive effect on the ability to safely raise issues. New national helplines are providing further support to staff.

Patient care and people management

Finally, although I could include leadership, recruiting for values and a range of other areas, I think the major development has been the growing appreciation and evidence of the link between staff experience and patient care.

There has been a growing area of research in the NHS showing the links between good people management like appraisals, engagement, health and wellbeing and training, and it’s clear that this is having an impact not just in HR departments but in board activities. Good. But we need to see this less as ‘programmes of action’ and more about fundamental change in our approach to people management.

Instead of trying to work out how we can get employees to serve organisational goals, let’s ask how the organisation can serve our employees to deliver for patients. Get this right and the progress made in changing organisational culture becomes embedded in the DNA.

Still more to do, but today is a great opportunity to talk up the NHS and the staff, managers and leaders that have committed their careers to it.

Dean Royles is the chief executive of NHS Employers and a HR magazine blogger