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Francis says nursing lacks 'unified voice' that ministers cannot ignore

Nurses have the power to “transform” care in failing healthcare organisations but the nursing profession itself lacks a “unified voice” to challenge the government, according to Sir Robert Francis.   

In a warmly received speech to the Royal College of Nursing’s annual conference, Sir Robert thanked nurses for all the work they did and described nursing as both a “vocation and a profession”.

“At its heart and soul nursing is a profession and a vocation, which is devoted to the care of patients”

Robert Francis

The former chair of the Mid Staffordshire Foundation Trust public inquiry said: “We forget at our peril just how important good nursing is to the wellbeing of patients and the effective running of the health service.”

“I fear that over the years all of us have been taking nursing and our nurses too much for granted,” he said. “Nurses have begun to be seen as a means to make the hospital production line run more smoothly and efficiently, as instruments to achieve various targets. 

“At its heart and soul nursing is a profession and a vocation, which is devoted to the care of patients,” he said. “If we the public – and those who run the healthcare system – do not value and cherish that central fact, nursing becomes just another job.”

Sir Robert called on nurses “first and foremost” to value themselves and their work, and “above all” their patients. 

“I believe nurses have it in their power as professionals… to transform places of poor care into places of excellence,” he told delegates.

But he added: “Too often we see reports of nurses raising concerns, often time and time again, and then they don’t’ hear any more. That is absolutely inexcusable.”

He noted, however, that an individual nurse would “always be weaker” when trying to act by themselves and called for more at senior levels. “The individual nurse who raises honestly held concerns about matters affecting patients should never be left to fight for them alone,” he said.

He called on trusts to appoint more nurses into non-executive director roles and to encourage groups of nurses within organisations “to voice their shared concerns”.

Sir Robert also warned managers not to “slide back to a reliance on the excuse of finance to fail to deliver proper standards”. “Paring staff to the bone without proper provision for patients needs to remain unacceptable,” he said, in reference to the chronic short staffing in parts of Stafford Hospital.

“What seems to me to be missing is a unified approach… that provides a view which neither government nor the health secretary can afford to ignore”

Robert Francis

But Sir Robert also reiterated doubts about how effectively nurses were represented at a national level.

He was “unsure” about the government’s decision to relocate the chief nursing officer for England’s post from the Department of Health to the new commissioning body NHS England, he said.

“Is she in the best place to give public prominence and recognition to the importance of the voice that you all collectively have?” he asked, repeating a point made in his report last year.

Similarly, he said the RCN’s dual role as both a trade union and a professional body weakened it as a “collective professional voice of nursing”.

“Politicians, employers and patients are too easily persuaded that a trade union voice is driven by self- interest,” he said. “What seems to me to be missing is a unified approach… that provides a view which neither government nor the health secretary can afford to ignore.

“There is a need for some more identifiable, authoritative body, which is recognised and has the authority to speak for the profession on issues of patient safety and quality of service,” he added.

Speaking to a packed conference hall, Sir Robert identified areas he thought had improved since the publication in February 2013 of his seminal report into care failings at Mid Staffordshire.

“I believe there is actually much to be encouraged by,” he told delegates, highlighting in particular improvements around “openness” in the NHS.  

“We no longer have constant denials that anything is wrong,” he said. “Accurate and fair observations regarding poor standards are good for patients and actually good for staff as well.”

He welcomed the introduction of a statutory duty of candour for healthcare organisations and the Care Quality Commission’s new inspection regime.

“The duty of candour should make it easier for nurses to speak up when they are worried something has gone wrong, and the inspections… should expose leaderships which do not welcome the raising of concerns,” he said.

Sir Robert finished by calling for the lessons of Mid Staffordshire to be applied beyond acute hospitals into community, mental health and primary care settings.


Keep up with all the news and debate from RCN Congress 2014 with our rolling news digest


Robert Francis QC

Sir Robert Francis addresses RCN Congress

Readers' comments (6)

  • michael stone

    I keep commenting that Sir Robert is an excellent analyst, who expresses his conclusions very clearly.

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  • Isn't is sad that Sir Robert has reprensented nurses and nursing at this conference more passionately and eloquently than our Chief Nurse?

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  • tinkerbell

    I like Robert Frances QC, and his plain speaking, he is telling it like it is in crystal clear plain English. He needs to be listened to cos' he doesn't have any conflict of interests, he supports nurses and patients equally and after all nurses and patients should be united and represented by someone who does not have a conflict of interests, unlike the RCN.

    Anonymous | 19-Jun-2014 3:20 pm

    Yes, very sad. Probably too scared they'll lose their job/position etc., if they speak up for us honestly.

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  • Sir Robert has articulated everything that most sensible commentators on these boards feel, and very much more eloquently. When WILL our chief nursing officer and unions speak up for nursing in the same way? We have the structures and the feedback mechanisms for a "unified voice", and it is the job of the chief nursing officer to seek views, observe what is happening on the front line, and support and advocate for the profession in a direct, assertive and knowledgeable manner. I do not see this happening, and even now the majority of nurses in my Trust have not heard of the pointless and patronising 6 "C's". Robert Francis has done a better job with this single article.

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  • michael stone

    'Probably too scared they'll lose their job/position etc., if they speak up for us honestly.'

    Indeed Tink - the people within 'systems', are typically inhibited from speaking openly and honestly. Either by 'fear' or by 'corporate responsibility'.

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  • managers have become totally systems obsessed to the extent that they are no longer people focused. it is the way they are trained and have a very different role from clinicians but their system is in place to provide a supportive structure for clinicians and patient care not a fight to try and take over this latter groups expert decision making and care. Fools, those who think otherwise!

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