Intended for healthcare professionals


Government’s initial response to Mid Staffordshire report

BMJ 2013; 346 doi: (Published 09 April 2013) Cite this as: BMJ 2013;346:f2209
  1. Tony Delamothe, deputy editor
  1. 1BMJ, London WC1H 9JR, UK
  1. tdelamothe{at}

Something old, something new, something borrowed, some things worryingly missing

The message that Robert Francis took from his two inquiries into the events at Mid Staffordshire was that patients should become “the first and foremost consideration of the system and everyone who works in it.”1 2 In its initial response, the government has accepted most of his 290 recommendations, “either in principle or in their entirety.”3 4 More detail is promised for later, but Patients First and Foremost sets out the government’s key early priorities.

Some of the government’s responses—such as a wholesale rethink of nursing recruitment and training—map closely on to Francis’s recommendations. But others are completely new, surprisingly, given that there are so many well thought out recommendations to choose from. Several are lifted directly from the inspection regime of English schools—the most headline grabbing one being a chief inspector responsible for issuing ratings. The Care Quality Commission will appoint the chief inspector, who “will become the nation’s whistleblower—naming poor care without fear or favour from politicians, institutional vested interests, or through loyalty to the system rather than the patients that it serves.” Because the evaluations will depend heavily on inspections by the commission, which has its own chief executive, it’s hard to discern the justification for …

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