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Roger Kline: 'With Francis' main concerns ignored, expect more scandals'


There is not a squeak of any measure to prevent the bullying that was so prevalent at Mid Staffordshire, says Roger Kline

“We must ensure,” said health secretary Jeremy Hunt in January, “that the compassion that led nurses and healthcare assistants into the profession does not get ground out of them.”

Four weeks later, the report on the Mid Staffordshire inquiry by Robert Francis QC showed what happens when excessive workloads, diluted skill mix, bullying and the sacrifice of patient care for financial targets grind compassion away.
Four weeks after that, the 2012 NHS staff survey showed that one in four NHS staff were bullied at work last year and even more fear the consequences of raising concerns. It’s no wonder that the number of reported incidents fell by 100,000 last year just as the NHS was facing the perfect storm of rising demand and funding cuts.

Another four weeks later, the health secretary published the government’s response to the Francis report and then, on April Fool’s Day, ushered in the chaos of the Health and Social Care Act. The one piece of good news was the new duty of candour, which should help ensure trusts are more honest with patients and staff.

“Almost no one emerged well from Mid Staffs other than the courageous patients’ and relatives’ group led by Cure the NHS founder Julie Bailey”

Yet almost none of the key causes of the Mid Staffordshire scandal identified by Mr Francis have been tackled. There is no regulation of healthcare assistants, even though most trust chief executives support this; it beggars belief that the person treating your cat is better regulated than the person caring for your mum or dad. There is not a squeak of any measure to prevent the bullying so prevalent at Mid Staffordshire and elsewhere. There will be no effective regulation of poor general managers. Nurse managers and medical leaders who behave badly may have their careers terminated but poor leaders who are not clinicians remain virtually unregulated.

To rub salt into the wound, nurses are singled out as so lacking in compassion they must spend a year as healthcare assistants (unregulated) to learn compassion.

After the Bristol Royal Infirmary baby deaths inquiry a decade ago, we were told such a scandal must never happen again. It did, in Mid Staffordshire. I recommend you read the summary recommendations of the 2001 Bristol inquiry; they are shorter but otherwise remarkably similar to those of Mr Francis 12 years later.

What is worse is that, thanks to Professor Brian Jarman, the trust and region were warned something appeared to be seriously wrong, but they ignored the warnings. NHS chief executive Sir David Nicholson, who recently announced he will retire in March 2014, once led the regional NHS and admits he “failed to make the care and safety of patients [his] first concern”. Between Mr Hunt’s disastrous upheaval in NHS structures and the impact of Sir David’s funding cuts, we have a certain recipe for future scandals.

Almost no one emerged well from Mid Staffs other than the courageous patients’ and relatives’ group led by Cure the NHS founder Julie Bailey.

The Nursing Times Speak Out Safely campaign encourages staff to raise the alarm and seeks to protect them when they do so. It is a scandal that many staff still rightly fear the consequences of whistleblowing. Every week, along with colleagues in Patients First, I hear examples of NHS staff from all walks of life who have raised concerns and then paid a heavy price. If Mr Hunt is serious about stopping compassion being “ground out” of NHS staff, then protecting those who blow the whistle before it happens should be a top priority.

● Sign the Speak Out Safely petition at

Roger Kline is a director of Patients First, a visiting research fellow at Middlesex University, and the author of The Duty of Care, a free download from


Readers' comments (59)

  • Thanks Roger an excellent summery of the situation.

    No clinician (of whatever breed) is safe when "raising concern" The "management" will in the first instance ignore and pretend not to hear any expressions of concern.

    Persist and then the bullying will commence. It will be subtle at first but will rapidly become ferocious.

    Lies will be whispered about an individuals competency, accusations of "mental health" issues will be raised. Disciplinary investigations will be commenced. Individuals will be suspended and reported to the professional regulators.

    Many will buckle under the pressure and be lost to their profession.

    Should the whistle be blown ?

    YES it should but anonymously!

    I believe that the CQC having escaped from the tyrannical rule of Ms Bower is transforming into an organisation which is part of the solution and not, as in the past, a definitive part of the problem.

    If your patients are being put at risk by "managers" or indeed anyone else make a report to the CQC anonymously.


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  • thanks for finally saying what us nurses have been trying to tell everyone - we have had enough of all this tripe, we just want to go to work, be able to do a good job that we were trained to do.

    can you report shortstaffing and poor skill mix to the CQC, if so does it come under 'whistleblowing' - I am not sure how to do this but I want to.

    does anyone else think that the term 'whistleblowing' puts nurses off reporting, it makes me feel like I am a sneak instead of someone just trying to improve things for all concerned.

    I battle every shift knowing that there are not going to be enough staff on duty, or the staff that are on don't have the right skills - I battle with the question I am asked everytime I apparently 'moan' which is 'what's the alternative, there are no staff'. If there is a national shortage of trained nurses then the only solution is to close beds and I don't think that will happen.

    I dread going into work most shifts now, as do my colleages.

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  • "If there is a national shortage of trained nurses then the only solution is to close beds and I don't think that will happen."

    If a lot of nurses' posts were recently slashed how can there be a national shortage? have all of these left the profession or are the job seekers.
    numbers of nurses entering training need to be realistic and conditions need to be made attractive to encourage job seekers back.

    closing more beds when there is already a shortage will just exacerbate the problems in A&E and shoving patients on trolleys into the corridors and cupboards where they are not being attended to or receiving adequate care.

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  • tinkerbell

    Anonymous | 28-May-2013 9:43 am

    I think the term 'whistleblower' should be changed to something more positive and have thought this for a long time.

    Likewise I agree with you.

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  • tinkerbell

    Makes me wonder what nicholsons first concern was then if it wasn't the care and safety of the patients. I can guess. Money.

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  • tinkerbell | 28-May-2013 10:13 am

    I think he believed he was running a business like any other where balance sheets and generating positive figures are the first priority and how you achieve this is secondary.

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  • Hunt just keeps coming up with more ideas out of the top of his head without showing any understanding of the real issues or of how the entire NHS and healthcare processes actually work as far as delivering front line professional services and the resources required for them are concerned. there were further articles on his wild and unworkable schemes in yesterday's telegraph.

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  • We have the Chief Nurse for England, Jane Cummings sitting in the D of H doing nothing useful. No wonder Francis said there was a lack of leadership at the top of nursing. What does she get paid for apart from being Mr Hunts Poodle?

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  • All very true, Roger - thank you for spelling it out so clearly. The term 'whistleblowing' causes concern, but does anyone have an alternative to suggest?

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  • Pirate and Parrot

    tinkerbell | 28-May-2013 10:11 am
    annsey | 28-May-2013 1:49 pm

    Didn't someone suggest culture champion, as the theme is creating a more open culture in the NHS, with staff more active in raising concerns? I'm pretty sure the point was discussed a while back.


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