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OPINION

Dean Royles: 'The horrors of Mid Staffs need a system-wide response'

  • 31 Comments

With the publication of the Francis report looming, Dean Royles looks at what it may mean for the NHS

If 2012 was the year of the Health and Social Care Act, 2013 seems likely to be the year of the Francis report.

It will let us take a long, hard look in the mirror.

A lot of extraordinary, unconditional care is given in the NHS and staff often show enormous bravery. I have often taken the view that the considerable amount of great care can somehow compensate for occasional poor care, while recognising the individual distress that this causes.

However, this argument is no longer good enough.

In some areas, we are seeing an erosion in public confidence, with distressing stories about seriously ill patients asking not to be taken to certain wards and fears over the Liverpool Care Pathway. Comments about the “normalisation of cruelty” have made me take a long hard look at myself, my views and my values.

How do we, as employers of 1.2 million staff, convince the public that we are just as passionate about high-quality care as they are, that our commitment to good care is what gets us up in the morning and that we don’t just consider the balance sheet?


There is a lot of speculation about the Francis report. There is a widely held view that it will lead to a tsunami of change. Could it be coming at the worst time or the best time? Will huge financial challenges in the NHS prevent its recommendations from being implemented effectively, or will they provide the impetus for significant cultural change?

Regulators, professional bodies and other organisations will sense they have a part to play. It’s going to be significant for the HR function, which is often seen as the curator of organisational values - values that can both deliver exceptional care or fail patients.



All of us in the NHS will need to show that we are as determined as the health secretary will no doubt say he is to restore public confidence. Anything less will be a disservice to patients and the public.



Will the report recommend the regulation of managers? Would this apply to all managers, including registered professionals - or just board directors? Would it be voluntary or mandatory?

There has also been a lot of speculation from professional bodies about the regulation of healthcare assistants and minimum staffing ratios. Other organisations, including NHS Employers, have taken a cautious stance. Would minimum staffing ratios signal a staffing ceiling rather than a floor? What would this mean for the professional role of the ward manager, who is often best placed to judge the right mix of staff? Would regulating HCAs improve safety and dignity, or just allow a sanction after failure? Would it be better if instead of regulation we invested in developing standards, ensured access to training, provided good supervision and recruited and appraised staff against core values?


Any new approach should focus on early identification and support to keep patients and services safe, rather than identify poor performance after a tragedy. That will always be too little, too late.

It is essential that staff should be able to raise concerns but the NHS staff survey shows that around half of employees have no confidence action will be taken if they do so. We must put this right. Acting quickly and comprehensively on this has to be a top priority. Training, culture, leadership and policies will all play a part.



I - like many others - am speculating and taking a long, hard look in the mirror. We need a government and system-wide response to Francis and the horrors of Mid Staffordshire that will get us beyond the flurry of press coverage to sustainable solutions. These need to unite clinicians and managers in a common aim to provide the best-quality care, when care and compassion are what matter most. That’s what I hope the legacy of Francis will be.

Dean Royles is director of NHS Employers

Do you want to keep up to date with the latest from the Francis Report into the Mid Staffordshire Foundation Trust? Visit our tailored Francis Report channel with the latest rolling news and analysis

  • 31 Comments

Readers' comments (31)

  • michael stone

    'Would it be better if instead of regulation we invested in developing standards, ensured access to training, provided good supervision and recruited and appraised staff against core values??

    Any new approach should focus on early identification and support to keep patients and services safe, rather than identify poor performance after a tragedy. That will always be too little, too late.

    It is essential that staff should be able to raise concerns but the NHS staff survey shows that around half of employees have no confidence action will be taken if they do so. We must put this right. Acting quickly and comprehensively on this has to be a top priority. Training, culture, leadership and policies will all play a part.'

    As I've commented before, I feel sure a major problem is that 'te culture' of the NHS seems to be that:

    1) If anything is 'significant or serious' it has to written down somewhere;

    2) If it isn't written down, or going to be written down, it isn't serious - and will not be taken seriously.

    The consequence of this, all too often, is that if you raise an issue 'below the level of a formal complaint', nobody pays much attention, because it isn't a formal complaint.

    If you formally complain, everyone tends to become 'very deensive', and instead of objectively looking at the possible problem, people are much more concerned with makings ure any blame will end up on someoen else.

    That is what has got to be changed - it has got to become possible, to 'think fairly hard about' concerns, without turning things into formal complaints and slowing the process down to 'fill-in this form, hold that formal meeting, record this, fill-in that, write to .... ' etc !

    I've just posted some initial thoughts, about a sort of network of 'Cultural Champions', in another discussion.

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  • Royals is well aware that the Mid Staffs disaster was rooted in despicably poor "management".

    All that mattered at Mid Staffs was achieving "Foundation" status patients did not matter and in fact where a nuisance. As a result many died of "management failure"

    Nursing staff were deliberately reduced by 100s, nursing skill mix was decimated by the employment of (cheap) care assistants. Warning signs were ignored and Whistle blowers bullied and hounded out of their jobs.

    Mr Royals is fully aware of the "macho" management style which has been widely adopted as a "productive" model !

    Royals supports the "consortia" who are actively engaged the attempt to destroy clinical staffs terms and conditions of service !

    The NHS "culture" of rewarding the failure of senior managers is well known and documented. Basically two forms of reward --1) Negotiate a settlement amounting to £0000s +large pension entitlement walk away to be re-employed in the NHS as a "Consultant" a few weeks later OR 2) Be promoted away from the trouble preferably to a better paying post !
    Mr Royals and his colleagues should be afraid it is alleged that attempts have already been made to have the Francis report watered down. Criticism of management is said to snake all the way from trusts to Whitehall

    I sincerely hope Mr Francis recommends an end to the NHS management system which is focussed on bonus payments and salary increases whilst the plebs suffer pay freezes.

    A system of open, transparent management is badly needed within which failure is rewarded with dismissal without the benefit of a "golden goodbye" and a promise of re-employment.

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  • I fully agree with Jenny, lets stop pretending that this is about Nurses and Doctors and admit this is about a culture where Chief Execs and their lackeys can make or break a Hospital. They have far too much power, if they choose to ignore clinical staff concerns and patients best interest they can do so without any fear of reprisals.

    It's time for the Government to make it clear that Hospital managers are accountable for their actions and the buck stops at the top - some hope!

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  • HEY Royles !!

    Yet more evidence emerges of currupt, inept and grossly incompetent "management!

    ALL the folowing have recieved "Warnings" from the CQC ----

    Scarborough Hospital; Milton Keynes Hospital; Royal Cornwall Hospital; Walton Centre NHS Foundation Trust in Liverpool; Queen’s Hospital, Romford; Stamford & Rutland Hospital; Southampton General Hospital; Croydon University Hospital; Bodmin Hospital, Cornwall; Northampton General Hospital; St Peter’s Hospital, Maldon; Queen Mary’s Hospital, London; Chase Farm Hospital, London; Westmorland General Hospital; Pilgrim Hospital, Leicestershire; St Anne’s House, East Sussex; and Princess Royal Hospital, West Sussex.

    The warnings concern the deliberate and cynical attempts by "Management" to provide services with insufficient staff!

    These "Managers" who's actions place patients at risk must be publicly named, shamed and removed, without compensation, from the NHS.

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  • Jenny Jones - where did you get your info from? I would be interested in reading it.

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  • there was an article on this in yesterday's telegraph online but articles have also appeared on the incompetency of the the CQC - all very confusing!

    there is also one on Hunt on the shortage of nurses!

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  • Anonymous | 13-Jan-2013 11:15 am

    Sorry I should have posted my source!

    If you look in the on line health section of todays Telegraph you will find the detail.

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  • Tinkerbell

    i once completed an incident form stating the staffing levels were 'dangerously low' many years ago.

    I was called to the managers for a meeting.

    They wanted to discuss my 'inflammatory' use of the word 'dangerous'. Other than that the wording was approved. Nothing came of it.

    What a farce!

    So what is to become of hunts pseudo concerns of 'dangerously low staffing levels' Is any action going to be taken?

    What is to become of the Francis report, i would love to think that all these reports aren't just lip service, that something good will happen and action will be taken, but i think there is a very dusty shelf somewhere, a room 101, where they are all stacked up mile high.

    Voicing concerns is one thing, actioning them is another. If you have it within your power to change something for the better then do it please. It's what we DO that counts.

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  • tinkerbell | 13-Jan-2013 12:36 pm

    did you do a cost/benefit analysis on that meeting?

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  • Tinkerbell

    Anonymous | 13-Jan-2013 12:39 pm

    sorry as the only nurse in charge had to get back out and nurse the people but did continue to fill out incident forms and use the words 'dangerously low staffing levels' and encourage all my colleagues to do the same.

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