Feature BMJ Round Table

After Francis, what next for the NHS?

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2074 (Published 10 April 2013) Cite this as: BMJ 2013;346:f2074
  1. Adrian O’Dowd, freelance journalist
  1. 1Kent, UK
  1. adrianodowd{at}aol.com

Following the landmark Francis report into what went wrong at Mid Staffordshire NHS Foundation Trust, a panel of experts gathered at a BMJ round table discussion held during the Nuffield Trust 2013 health policy summit last month to discuss how the report’s recommendations could change the NHS. Adrian O’Dowd reports.

What are the main points that people should take away from Robert Francis’s report into Mid Staffs? That was the question with which BMJ editor in chief Fiona Godlee, chairing the session, began discussions with the panel of experts, whom she said were there to help consider what was likely to and should happen to the NHS after Francis.

Julie Moore, chief executive of University Hospital Birmingham and chair of the Shelford Group, made up of leading academic teaching hospitals, said: “I think one of the things that the Francis report pointed to is how many people are currently involved in monitoring, overseeing, and regulating quality—and I think one of the key points was to simplify that.”

Bruce Keogh, medical director of NHS England, formally the NHS Commissioning Board, said quality should start within an organisation itself, adding: “We’ve got an NHS that employs 1.4 million people, and each and every one of those people has a contribution to make.

“Every professional that has to deal with patients sets the tone for quality of that organisation, and the role of the organisation is to set an environment which encourages appropriate behaviour in that encounter and supports it.

“Frankly, if that worked, you wouldn’t need a regulator for quality. It would be ingrained in the system. I get worried that whenever something goes wrong we blame the regulator. The blame is placed very high up in the system when actually the problems are deep in an organisation if there are issues …

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