2. Background to Francis Report To examine the operation of the commissioning, supervisory and regulatory organisations and other agencies, including the culture and systems of those organisations in relation to their monitoring role at Mid Staffordshire NHS Foundation Trust between January 2005 and March 2009 and to examine why problems at the Trust were not identified sooner, and appropriate action taken.

3. Francis Report 1 million pages of documentary material 250 witnesses 139 days of oral hearing Costs £13 million Report February 2013 (2 years) 1781 pages 125 pages –Executive summary 290 recommendations

4. Warning signs Patient stories not acted on Mortality – not acted on Complaints – inadequate management Staff concerns – adverse surveys no action Whistleblowers – no action Professional disengagement - consultants Clinical governance issues - poor Finance Staff reductions – no risk assessment

5. Staff concerns I mean in some ways I feel ashamed because I have worked there and I can tell you that I have done my best and sometimes you go home and you are really upset because you cant say that you have done anything to help. You feel that you have not – although you have answered buzzers, you have provided the medical care but it never seemed enough. There was not enough staff to deal with the type of patient that you needed to deal with, to provide everything that a patient would need. You were doing – you were just skimming the surface and that is not how I was trained. A nurse © Robert Francis 2013

6. Staff concerns The nurses were so under-resourced they were working extra hours, they were desperately moving from place to place to try to give adequate care to patients. If you are in that environment for long enough, what happens is you become immune to the sound of pain. You either become immune to the sound of pain or you walk away. You cannot feel people’s pain, you cannot continue to want to do the best you possibly can when the system says no to you, you can’t do the best you can. An A+E doctor ©Robert Francis 2013

7. Disengagement Perhaps I should have been more forceful in my statements, but I was getting to the stage where I was less involved and heading for retirement… I did not have a managerial role and therefore I did not see myself as someone who needed to get involved. Perhaps my conscience may have made me raise concerns if I had been in management role, but I took the path of least resistance. In addition… most of my patients were day cases and there was less impact on those patients. There were also veiled threats at that time, that I should not rock the boat at my stage in life because, for example, I needed discretionary points or to be put forward for clinical excellence awards. ©Robert Francis 2013

8. Underlying culture ©Robert Francis 2013 Pressure targets finance jobs Pressure targets finance jobs Reaction fear low morale isolation disengagement Reaction fear low morale isolation disengagement Behaviour uncaring unwelcoming bullying keeping head down Behaviour uncaring unwelcoming bullying keeping head down Habituation tolerance denial someone else’s problem Habituation tolerance denial someone else’s problem

9. Francis Recommendations (290) Common values – put patients first Fundamental standards – food/water/medication/consent/toilet care Openness, transparency and candour – welcoming complaints/ information about performance/informing patients when harmed Compassionate, caring, committed nursing Strong patient centred healthcare leadership Accurate, useful and relevant information – active Patient/Public involvement Culture change not dependent on Government

10. The King’s Fund 2013 “Even if all 290 recommendations were implemented now, the fundamental shift in culture can only be achieved if patient care is put top of the agenda for boards and is the first responsibility of professionals working in the NHS. That will take time and commitment over many years.”

11. Your hospital? The Francis report is not about Mid Staffordshire but the NHS All healthcare professionals need to be involved in advocacy for patients It is about caring and compassion for all healthcare professionals not just the nursing profession We need to open our eyes and view our workplace through the patients eyes.