Intended for healthcare professionals

Rapid response to:

Feature BMJ Round Table

After Francis, what next for the NHS?

BMJ 2013; 346 doi: (Published 10 April 2013) Cite this as: BMJ 2013;346:f2074

Rapid Response:

Re: After Francis, what next for the NHS?

The government response to Francis has been shocking in its understated approach so far. Francis concluded that there had been failures at every level of the health service, and yet the focus has been on nursing failures. Repeated statements from government , health ministers and unions state that the culture in the NHS must change, but has not thrown its weight behind looking at the issues facing whistleblowers and the links to bullying.

As a consultant paediatrician, I experienced what it was like working in a severely understaffed with a poorly communicating team. Raising concerns was seen as subversive behaviour by my employer at the time. I was criticised for being "too caring." Patients' families who spoke out about the unacceptable poor levels of care in Stafford have allegedly been personally threatened and this has now been reported to the police. Nurses in Stafford tried to raise concerns but were threatened or ignored.It is crucial that the government supports patients' families and the frontline by holding those people to account who have been shown to have misused NHS money, or tried to cover up failure, and that is across the NHS.

Policies such as the "NHS Constitution" look good on paper but this needs to be enforced. Mid Staffs should be a wake up call, not only to the frontline, but to anyone with the power to make a change in the culture. We need to start doing what we say we will do and stop wasting money on burying mistakes, often by paying large amounts of money for secret and flawed investigations.

To learn more about Patients First campaign for more NHS openness and transparency go to

Competing interests: No competing interests

18 April 2013
Kim M Holt
Consultant Paediatrician
Patients First
London N12 ODR