Francis won’t be drawn on resignation of NHS head in wake of Mid Staffordshire inquiry

BMJ 2013; 346 doi: (Published 01 March 2013) Cite this as: BMJ 2013;346:f1419
  1. Matthew Limb
  1. 1London

Robert Francis QC, whose inquiry into Mid Staffordshire NHS Foundation Trust damned systemwide failings in care, has refused to be drawn into calls for the resignation of the head of the NHS.

Francis was asked directly at a King’s Fund conference of health experts in London on 27 February whether David Nicholson, chief executive of the NHS Commissioning Board, should resign.

The question was put by Nick Timmins, a senior fellow at the Institute for Government and the King’s Fund, who noted that the inquiry had insisted that there should be no “scapegoats” while demanding greater accountability in the NHS.

Francis said that he would not answer the question as it was not the job of a public inquiry to “put someone on trial” or “pronounce sentence” on individuals.

He said, “Had that approach been adopted, this inquiry would have lasted longer than the Bloody Sunday inquiry, it would have cost more, and it would not have achieved any of the learning points we are now talking about.”

A report in the Daily Telegraph on 27 February said that some cabinet ministers privately believed that Nicholson, who led the strategic health authority charged with overseeing the Mid Staffordshire trust, should now stand aside.1

Francis made 290 recommendations after his inquiry into mismanagement at Stafford Hospital, which is estimated to have led to the deaths of between 400 and 1200 people from January 2005 to March 2009.2 3 4

He was at the conference to outline his findings and discuss their implications for the health system with a panel of experts and a packed audience.

Peter Walsh, chief executive of the patient safety charity Action against Medical Accidents, said that the Francis report could mark the start of a better era for the NHS but that continuing debate about the NHS’s leadership could “get in the way of recommendations and action being implemented.”

Walsh said that if he himself led an organisation whose “continued presence as chief executive would harm the credibility of the movement for change and moving forward I know what I would do: I would resign.”

Francis said that the inquiry’s terms of reference had focused his attention on organisations and the culture of the NHS.

He explained, “If you want to judge your leaders . . . then the test I think should be how they are, in what they do, reflecting the lessons to be learnt from this report, how are they evidencing whether they accept those lessons, and how are they evidencing they are putting in place within their own sphere the changes that are necessary to do that.”

He added, “We should concentrate on that rather than on me taking a judgment as to whether A or B should resign or stay in their job. That was not my job, and I’m not going to take it on.”

Walsh said that ministers should state clearly whether they were prepared to accept the Francis report’s recommendations and support their implementation, rather than pay lip service to its broad themes and principles.

“Anything else would . . . add insult to the injury of patients around country who have lost loved ones,” he said.

Francis told the conference that patients and relatives in Stafford had experienced “the most appalling care imaginable.”

He said that his inquiry had cost £13m (€15m; $20m) and that the government was due to give a response to his report at the end of March.

“Why are we waiting?” he asked. “There’s much in this report which doesn’t require a change of law or a policy guidance from the Care Quality Commission or anything other than a change in attitude on the part of people. Everyone in this room who has a job in the health service can start doing something that makes a difference.”

David Behan, chief executive of the regulator of the NHS and social care services, the Care Quality Commission, said that the “seminal” inquiry report had posed a huge leadership challenge for health and social care, at a time when “trust in British public life and institutions is at its lowest I can remember.”


Cite this as: BMJ 2013;346:f1419