Back to insights

The Francis Report and the Implications for Healthcare

30 January, 2014

What is the Francis Report?

A public inquiry was held into the poor standards of care experienced by patients at Mid Staffordshire Foundation NHS Trust, which was chaired by Robert Francis QC, a barrister with clinical negligence experience.

The Government has accepted most of the report’s recommendations, and key changes to healthcare management and regulation are being implemented which will apply to all NHS and independent healthcare providers.

What happened at Stafford Hospital?

There has been wide coverage in the media regarding high mortality rates, appalling lack of care, and a callous disregard for patients’ rights and dignity which occurred at Stafford Hospital.

It was reported that, there was a “profoundly wrong culture from Ward to Whitehall”. The professionalism of staff was worn down by a “web of negative culture”, which included bullying and not acting on staff concerns or patient complaints. Senior management focussed on targets, reducing costs and achieving Foundation Trust status.

How can another hospital healthcare scandal be prevented?

All healthcare providers should review the Francis Report and decide how to implement the recommendations.

There needs to be a common culture of caring, according to Francis, which will include openness, honesty and transparency with a focus on putting the patient first. Staff should follow standard procedures and managers ensure compliance.

Understaffing of nurses was one of the problems, so NICE will be providing guidance on staff levels for different care settings and hospitals will be required to publish their staff levels.

Revalidation and training for nurses to ensure fitness to practice will be required and national standards and training for healthcare assistants is recommended.

What will be the role of the regulators?

The regulators will be acting more independently and with an increased role which will include a “Zero Tolerance” approach to non-compliance.

The CQC has announced significant changes in the way it will conduct inspections, including the introduction of a new framework for monitoring, regulating and inspecting mental health services. This will be rolled out to all providers by October 2014.

The CQC will consider 5 factors when assessing a service:  safety, effectiveness, the level of care, responsiveness to people’s needs, and standard of management.

In addition, the CQC has announced that it will be using “expert inspectors” in future, who will specialise in particular sectors such as eating disorders or learning disabilities.

Areas that the CQC has stated it will focus on include:

  • Compliance with the Mental Health Act regulations 
  • Transitions between services such as moving from secondary care to primary care
  • Integrated healthcare for physical and mental health 
  • Feedback from service users, and patient’s representatives

Were there any specific medication management issues?

There was a specific recommendation relating to medicine administration which stated that:

“…the process of the administration of medication needs to be overseen by the nurse in charge of the ward, or by their nominated delegate. 

A frequent check needs to be done to ensure that all patients have received what they have been prescribed and what they need.”

How will Ashtons support hospitals to comply with medicine management standards?

Ashtons will continue to provide support with medication management compliance by working closely with staff on the wards, conducting checks and audits, and making best practice recommendations relating to medication.

Ashtons is developing products and services to improve compliance with regulations and quality standards and will continue to develop our training portfolio which will also include topics for healthcare assistants.

Full details of the government’s response to the Francis Report are available from