Intended for healthcare professionals


The year of Francis

BMJ 2013; 347 doi: (Published 18 December 2013) Cite this as: BMJ 2013;347:f7502
  1. Tony Delamothe, deputy editor
  1. 1BMJ, London WC1H 9JR, UK
  1. tdelamothe{at}

How do you change something as resistant to change as the NHS?

The government hit the ground running with the publication of Robert Francis’s report into the Mid Staffordshire NHS Foundation Trust on 6 February,1 and the pace hasn’t slackened since. In his accompanying statement to the House of Commons, the prime minister announced several immediate measures—and that was before detailed consideration of Francis’s 290 recommendations had begun.

These new measures included the creation of a single failure regime, whereby failures in care (and not just finance) could trigger suspension of a hospital board. Under a new test all patients, carers, and staff members would be given the opportunity to say whether they would recommend their hospital to their friends or family. The Care Quality Commission was asked to create a post of chief inspector of hospitals.

In addition, four new inquiries were announced that day—into patient safety, nursing qualifications, hospitals with the highest mortality rates, and patient complaints. A fifth—on the burden of bureaucracy—was announced a few days later.

Just seven weeks after the publication of the Francis report, the government published its initial response, flagging up its acceptance of most of the 290 recommendations.2 In addition, it fleshed out the new regulatory regime under the chief inspector of hospitals, which would provide a single clear rating for hospitals, …

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