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Francis response: What the healthcare unions thought


Nursing Times has collated the views of five major healthcare unions on the government’s response to the Francis report into care failings at Mid Staffordshire Foundation Trust.

The government’s full response to the Francis report into care failings at Mid Staffordshire Foundation Trust was published yesterday.

In its response report – Hard Truths: the journey to putting patients first – the government has accepted 281 of the 290 recommendations made by the Francis report in February.


Royal College of Nursing

On staffing and healthcare assistant regulation, chief executive and general secretary Peter Carter said: “We are pleased that the government has today acknowledged how critical it is to ensure safe levels of staffing on all of our hospital wards. This measure could have the single biggest impact on improving care in the NHS today.

“The RCN has been calling for some time for greater transparency in identifying the number of staff on each ward – by making this information available on a monthly basis we are going some way to ensuring that each hospital in the country offers patients access to the care they deserve.

“We also welcome the focus on consistent training for healthcare support workers through the Care Certificate. Although we remain convinced that the mandatory regulation of all healthcare support workers is the most effective way of protecting patients, the announcement today is an important first step.”


Peter Carter

On a new crime of wilful neglect, he said: ”Remedies already exist to tackle staff who are guilty of harming patients and we would question whether a new law is actually required.

“When things go wrong, as well as looking at the actions of an individual clinician, we also need to look at the whole system that surrounds a care failing. Too often, frontline staff are trying to deliver care against a backdrop of intense pressure and woefully inadequate staffing levels. 

“As well as the actions of individuals, it is equally important that we focus on the decisions that employers make about their staffing levels which all too often result in poor care.”



On staffing, head of health Christina McAnea said: “The government has missed another opportunity to introduce fixed, safe nurse to patient ratios.  There is safety in numbers when it comes to caring for patients and this one step would bring about a revolutionary change on the wards. 

“Recommending a “toolkit” to set minimum staffing levels is fine, but what will happen if these are ignored when wards are under pressure, which is almost a daily occurrence in today’s NHS.

“There is no doubt that some hospitals have become dangerously under-staffed because of government cuts.  It has ignored the warning signs and the calls from hospital managers, staff, patients and unions that more nursing staff were needed urgently.

“The focus on nurses is understandable, but it must not be forgotten that the culture of NHS organisations is dependent on the whole healthcare team.  It is important that issues of staffing levels and skill mix are considered on an organisational basis and not just within the nursing directorate.

ChristinaAmandakendalChristina McAnea

On healthcare assistants, she said: “The government says it has accepted the thrust of the recommendations in the Cavendish report, but disappointingly it is not supporting regulation for health and social care assistants. The proof of government intentions will also be dependent on whether it funds these developments such as training and improved pay.

“The response gives a framework for some welcome changes but I am not sure that it gets to the heart of the issue – which is about the culture and staff engagement.

On duty of candour, she added: “The statutory duty of candour is rightly being placed on the organisation, not on individuals.  This will enable staff to speak out more freely and safely -without fear of reprisals.  But we have concerns about a blame culture with blacklisting hospitals which goes against promoting openness and candour.”



On staffing, head of health Rachael Maskell said: “What Jeremy Hunt outlined won’t disguise the fact the public and staff can see there are not enough nurses.

“Are managers going to rob pathology to put a nurse on the ward, and then we will have a failed diagnosis scandal?

“Robert Francis reported in February and Hunt has sat on his hands, considering whether or not to do anything, while pressures on hospitals are increasing with cuts, privatisation and inadequate staffing levels.

“And our concerns are not just about the acute sector and A&E departments, but they also focus on inadequate staffing numbers in community nursing which put families at risk.

On whistleblowing, she said: “It is clear that that we need strong mechanisms in place for enabling staff and patients to freely whistleblow when they witness alleged abuses.

On healthcare assistants, she said: “Francis called for the regulation of healthcare staff, which Unite, patients and staff support, but Hunt has ducked this issue with a watered down ‘certificate of care’. This is not sufficiently robust enough.”


Royal College of Midwives

Cathy Warwick, chief executive, said: “Overall this is a robust and comprehensive response by the government. Safety, staffing and openness and transparency should be at the heart of the NHS.

Cathy Warwick

“If the government really follow up their commitments in this response then I hope we will see an even safer and better NHS and, a maternity service that has the right number of staff, with the right skills.

“This will lead to better care for the millions who rely upon the NHS to safeguard themselves and their loved ones, and who place their lives in its hands.”



Rehana Azam, national Officer for the NHS, said: “GMB is disappointed the government has ducked out of implementing all the recommendations of the Francis report.”

On duty of candour, she said: “A legal duty of candour will potentially have a big impact, requiring the NHS to be honest when mistakes are made. This needs a culture change, in particular among NHS management, and the legal duty is strong enough to make this happen.

“We already know that good staff engagement and good people management deliver better patient outcomes but we have some way to go to create a climate where staff can confidently raise their concerns constructively.”

On staffing, she said: “GMB considers that staffing levels and the mix of workforce skills are the key to ensuring care is at the level patients expect and deserve. It’s obvious from the government’s response, and their call for staffing reviews and numbers to be published, that they realise there is a serious problem with staffing in our hospitals and other parts of the NHS.

“By failing to set legal minimum staffing requirements, the government have ducked the opportunity to give patients a cast-iron guarantee they will be looked after in properly staffed hospitals.”

“It’s also disappointing the government has restricted the staffing reviews to nursing staff. Staffs on the bottom four pay bands in the NHS are responsible for 60% of contact with patients contact. GMB are concerned that this exclusive focus on nursing numbers will repeat the target-driven mistakes of the past.”


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Readers' comments (3)

  • tinkerbell

    5 unions, no action, unbelievable.

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  • No surprises here.

    And if we regulate HCAs, what are we regulating for? It's not skills or qualifications, since some staff are recruited with neither. Being a nice kind person doesn't seem to be something you can register!

    Managers already expect registered nurses to delegate work to HCAs that needs a knowledge base and professional judgement. It means they can keep up the overall 'nursing' staffing numbers by diluting the skill mix and pretending it's still a safe service. If HCAs are registered, they'll have the cheap, docile, unskilled nursing workforce they always wanted.

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  • HCA's will be "regulated" so that they can replace the old Enrolled Nurses, who had to lose their jobs or be retrained.

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