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Francis avoids direct criticism of top NHS leaders

The Francis report has criticised the work of the strategic health authorities which oversaw Mid Staffordshire Foundation Trust, but includes little direct criticism of specific leaders, including Sir David Nicholson.

Sir David, now NHS chief executive, was chief executive of Shropshire and Staffordshire Strategic Health Authority, which oversaw Mid Staffordshire Trust, from August 2005.

He was the lead officer ahead of the creation of the new West Midlands SHA until 2006 when he took over at NHS London before becoming chief executive of the NHS in September that year.

He has faced calls for his resignation in recent weeks, including from Julie Bailey, who leads the campaign group Cure the NHS.

The Francis report says, specifically of West Midlands SHA, but also related to the work of its predecessors: “The SHA made no link between its roles in relation to finance and workforce and how these may impact on patient and care quality – it prioritised targets and not patients and focused on finance not quality.”

However, the report includes no direct criticism of Sir David’s role.

It acknowledges the SHAs’ work was inhibited by the merger of the organisations at the time and said there was no policy to ensure quality oversight was maintained.”

The report also comments on Department of Health and senior NHS culture.

It says of the DH: ”It has overseen a system of performance management and regulation that has throughout the structure, relied in part on the assumption that other parts were working well, leading to a reduction in vigilance in relation to their own responsibilities.”

It also says there are elements of “negative aspects of culture in the system”, including “a lack of criticism”; “a lack of consideration for patients”; and “defensiveness”.

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