The Francis Report is a savage indictment of the cuts necessary to achieve privatisation

6th February, 2013 11:53 am

By Rachel Maskell

The Francis Report into the tsunami of failings at Mid Staffordshire NHS Foundation Trust is a savage indictment of the cuts necessary to achieve privatisation which is accelerating across the NHS.

The findings of Robert Francis QC are a stern wake-up call for politicians of all parties that the glossy prospectus of private healthcare companies taking over the NHS for the alleged benefit of patients is a chimera – and will lead to disaster and further fragmentation. It is clear that patient care and private profit, like oil and water, don’t mix. How much more evidence is required.

A complete overhaul of dysfunctional management in the NHS needs to happen as a matter of urgency and the first person out the door should be Sir David Nicolson, chief executive of the new NHS Commissioning Board – perhaps, the most powerful person in the coalition’s new NHS. In 2005, he was the regional NHS official who had the oversight of Mid-Staffs when the clinical failures were taking place. Later, as a NHS chief executive, he had accountability as to how the NHS responded as the scandal unfolded. The words ‘buck’, ‘stopping’ and ‘here’ have a certain resonance.

Once the anger has subsided, how best to proceed to guarantee that Mid Staffs is never repeated?

Unite, the UK’s largest union, is promoting the idea a network of ‘patient safety officers’ that should be established across the NHS to banish the culture of fear highlighted by the Francis Report. Patients, families and staff, wary of raising concerns about patient care through conventional channels, should be able to go in confidence to an independent ‘patient safety officer’ in place throughout all the provider and commissioning NHS organisations with powers to investigate and then order change. Unite is also calling for the creation of a National Intelligence Unit (NIU) – with a dedicated hotline for whistleblowers – to co-ordinate information about trusts that are causing concern.

These two recommendations are in a five-point response to the Francis Report that the union, which has 100,000 members in the health service, launched today. Unite said that it consistently raised concerns when the abuse was occurring and this was borne out by the witness statement that Unite regional officer, Mark Young gave to the inquiry. We believe that Mid Staffs is not unique and that the culture of bullying exists across the NHS – and poor morale leads to poor productivity.

The advent of NHS privatisation and the additional proposal that staff are subject to performance related pay, will further reinforce the culture of silence which will mitigate against concerns being raised. Ministers will use Mid Staffs as an excuse to allow the Health and Social Care Act to act as an express gateway for private companies to take-over large swathes of the NHS. The fact Mid Staffordshire was desperately seeking foundation trust status – the half way house to privatisation – when hundreds of people died unnecessarily proves the point that privatisation does not bode well for patient care.

It is not a coincidence that as Mid Staffs was spiralling into the abyss there were 150 nursing vacancies.

The key here is poor ‘watch your back’ management. Excellent clinicians are doing their best for patients against a background of £20bn so-called efficiency savings and they deserve a system in which they can raise professional concerns without fear of reprisal.

Health secretary Jeremy Hunt said that he wants patients treated as human beings, and not as numbers – now he has the opportunity to make this aspiration a reality.

Rachel Maskell is Head of Health at Unite

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  • ClearBell

    Unite’s idea is very good. Top marks for simplicity. After all private hospitals aren’t paragons for virtue and such an idea could be extended to them.

  • Well said, Rachel.

    Let’s hope Labour turn over a new leaf and include people like yourself, who value the NHS as public service and not as a profit grab opportunity, when it comes to devising health policy.

  • Dave Postles

    Formidable contribution.

  • My understanding is that this report was commissioned as a result of massive, almost catastrophic failings of Stafford Hospital between 2005 and 2008 – before the cuts, before the crash, and at a time of significant investment in the NHS from a Labour Government.

    If these dreadful failings in care had taken place in a private hospital, there would be the most almight political outrage from the Labour ranks. But still we are making political points about privatisation and cuts, even when this scandal happened in the NHS, under Labour, in times of plenty.

    People died – horribly. I think a little contrition is in order, don’t you?

    • Jonathan, the privatisation mentioned by Rachel Maskell (above) began well before Cameron became P.M. Indeed, Cameron has only carried on where New Labour left off.

      For very carefully researched accounts of the ongoing assault on the NHS as a public service, including New Labour’s complicity, you should read:

      Professor Allyson Pollock’s book, NHS plc.*


      Profs. Leys and Player’s book: The Plot Against the NHS**

      Contrition would be most appropriate if it came from those who supported New Labour’s NHS privatisation and marketisation and now want to pretend it didn’t occur.



      • Dave, are you saying ‘privatisation’ is to blame for what happened? Because as far as I can see, the Francis Report does not do so.

        • Please refer to opening paragraph above:

          “The Francis Report into the tsunami of failings at Mid Staffordshire NHS Foundation Trust is a savage indictment of the cuts necessary to achieve privatisation which is accelerating across the NHS.”

          • Quiet_Sceptic

            Well the opening paragraphs to the report conclusion points to problems at Stafford all the way back in 1998, again in reports in 2002 and onward.

            Privatisation as the catch-all cause of the problems just doesn’t stack up and isn’t supported by the conclusions of the report.

          • So how goes it with the problems associated by Francis with reorganisation (i..e privatisation by another name)?

            Clearly, when ideological ambitions unrelated to patient care (and without a shred of evidence* supporting the benefits that are predicted to follow) become a priority then management will be required to redirect resources away from what should be the core concern – putting patients first. This happened/is happening with New Labour’s and the Tories’ privatisation

            *When, for example, Allyson Pollock, as special adviser to the Commons Health Committee destroyed the economic case for PFIs in a series of articles published in the British Medical Journal she was replaced by a market friendly academic and was asked, disgracefully, by the head of the DoH PFI Unit if it was “in her career interests to brief against senior NHS officials”.

          • Quiet_Sceptic

            So why aren’t we having these same problems in every other NHS Trust then?

            If your theory of it being due to creeping privatisation is correct then why are these issue specific to Mid-Staffords and a handful of other trusts, why isn’t it more widespread?

            A quick review of the report points far more strongly toward the cause being very poor management and senior leadership with no effective process for removing poorly performing NHS managers and executives and driving up performance.

          • Problems are arising in other Trusts, as with those associated with Lewisham Hospital, where problems caused by years of political mismanagement are producing knock-on effects elsewhere. And there are more in the pipeline. All of these will have consequences for patient care.

            And further problems will arise within the newly formed Clinical Commissioning Groups – at the meeting I recently attended the Group voted through a proposal to hold meetings in private. These unaccountable groups are free to operate in secrecy. The voice of patients is being silenced.

            Interestingly, at Labour’s recent NEC meeting support was expressed for whistle-blowers but when the whistle was blown during Labour’s tenure, Labour decided, as the saying goes, to cock a deaf ‘un.

            The Tories are now doing the same. And for the same ideological reasons.

        • robertcp

          Jonathan, it does seem that so-called public sector reform did not help. People were too busy filling in stupid forms and meeting targets to care for patients.

    • Agree to an extent, Jonathan. I’d add that I saw Rachael Maskell speak two nights ago at a debate on the HSC Act reforms held at Guy’s Campus, KCL – she was very eloquent about the problems with the reforms, for example the huge and unsolicited distraction the reorganisation represented. The Unite response about patient safety officers, the hotline, the information unit etc sound interesting too. But I don’t entirely see the link between what happened at Mid Staffordshire, privatisation and the current situation either. Staffordshire was mostly about the overzealous pursuit of FT status by the trust board, though in light of how many trusts have acheived similar status without causing human suffering of the kind seen at Mid Staffs even that doesn’t damn the idea of FTs per se (whether they’re a “half-way house to privatisation” or a genuinely a good idea is a more divisive matter and mostly to do with your overall view of Labour’s 2000s-era reforms).

      Also, I don’t know whether I agree with Rachael about Nicholson needing to step down. I respect she may be speaking for Unite’s members in the health sector and I certainly agree he may to some extent be reponsible as former head of the relevant SHA for part of the crisis and more generally as Chief Executive since 2006. But right now, it would appear to me that there is an argument that the NHS needs continuity to face its various challenges – QIPP, the reorganisation and now the implementation of the Francis recommendations. Nicholson has been intimately involved with all three and thus represents substantial institutional memory. Him stepping down less than two months before the switch from PCTs/SHAs to CCGs and the Commissioning Board would presumably only create more uncertainty in the service.

  • One thing to remember about this terrible scandal is that the trade unions were trying to resolve these situations at every level that they could; and while the government were pouring the largest amounts of money into the N.H.S. ever, New Labour was also proving to the City that they were also preparing for privatisation of the service, only public/T.U. pressure stopped them from letting it rip, which left them with the dilemna of escalating care costs or cuts, lesding to situations like Mid. Staffs, and many more hidden scandals. With the scale of cuts which the coalition is railroading through the healt service(Lewisham, Rotherham being only the latest and imho, and many others) only the tip of the iceberg. People, be very aware, if noy afraid.

  • JK

    It seems a major component of the problems at Mid-Staffs was that the managers prioritised (Labour) targets and finances above the quality of care delivered. I have seen this happen to some degree in nearly every hospital I have worked since targets were introduced, and it is frustrating and upsetting for the majority of staff who are trying to deliver good care. When a report draws attention to a particular problem – e.g. hospital acquired infections, dementia, venous thromboprophylaxis – yet another target is created and managers suddenly focus on that issue, but all the other thousands of issues that exist are ignored, as they are not financially important to the trust. We cannot have central targets for every clinical event or diagnosis, so there needs to be another approach to the problem.

    One of the biggest issues is staffing numbers. The majority of nurses do an excellent job with the resources that they have but have to put up with understaffing and a proliferation of paperwork (only worsened by more targets). Each nurse can only be in one place at one time. Unless you give them the number of staff they require then no matter how compassionate the nurse they won’t be able to deliver the kind of care that patients and the public rightly demand.

    An open culture about mistakes such as the Francis report recommends is undoubtedly a good thing, but we should be cutting down on errors and poor care in the first place. I would like to see managers monitor the staff:patient ratios and the number of agency staff used and report this to a central agency (such as the CQC) on a regular basis along with their hospital acquired infection rates, death rates, complaint numbers etc. It’s not only a tragedy that Mid-Staffs happened, but that it went on for so long and none of the regulatory mechanisms seemed work. Reporting of data such as this could flag problems early and trigger an inspection / intervention much earlier. Managers should also be held accountable for serious failings in clinical care and not just rewarded for balancing the books. The GMC can sanction doctors and similarly the Nursing and Midwifery Council nurses, but what about managers?

  • JoeDM

    Labour doubled the spending on the NHS over its period in power and we ended up with a disfunctional, dirty, uncaring system.

    Where did all the money go? What a waste.

  • David B

    This happened under the last labour government. Trying to pin it on the current government by blaming current policies for what happened in 2005 to 2007is womg, unless it was Labour party policy to privaties the NHS at that time. Labour needs to learn from its mistakes or it will repeat them and more people will die!


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