The Francis Report



Described as the worst UK hospital scandal of recent years, up to 1,200 patients were estimated to have died as a result of poor care at Stafford hospital.

The £13 million Francis inquiry concluded this month and made 290 recommendations which will impact everyone working in healthcare. Here’s our briefing on what it means for junior doctors.

The scandal

The ‘Mid Staffs scandal’, as it has been referred to in the press, happened between 2005 and 2009 at Stafford Hospital – part of the Mid Staffordshire NHS Hospital Trust. Francis in his inquiry said that the trust’s pursuit of foundation status was one of the initiators for poor care. The drive to achieve this status led to ruthless targets and financial cuts which compromised safety.

The regulator, the Healthcare Commission, became alerted to the death rates which were abnormally high compared to other organisations. They identified a number of safety issues but progress was slow as the hospital dismissed some of the concerns as simply ‘coding errors’ and not safety issues.

A number of inquiries followed with each subsequent one discovering more shocking facts about levels of care at Stafford Hospital. Public outrage grew and a pressure group was formed to discover the truth. It called on the then Labour government for a full public inquiry.

In 2010 the new health secretary, Andrew Lansley, commissioned Robert Francis QC to conduct a formal public inquiry. Francis was a barrister and had worked on other NHS scandals – including the Bristol Royal Infirmary Inquiry into cardiac surgery in babies.

The inquiry

Francis initially planned to present the results of his inquiry in early 2011 but the scale of the problem at Mid-Staffs meant that it became a number of smaller inquiries.

The final report published this month was the fifth such inquiry.

The ‘Francis Report’ was finally published on 6 February 2013 and based on evidence from over 900 patients and families. It ran to 1,781 pages in total and this was a summary of over a million pages of evidence recorded during proceedings. In total the inquiry cost £13 million.

Speaking at the publication of his final report, Robert Francis QC said:

“I heard so many stories of shocking care. These patients were not simply numbers they were husbands, wives, sons, daughters, fathers, mothers, grandparents.”

“They were people who entered Stafford Hospital and rightly expected to be well cared for and treated. Instead, many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives.”

Key points

The Francis Inquiry stated that problems at the Mid-Staffordshire NHS Trust begin in 2006 when it was required to make a £10 million saving in order to achieve Foundation Trust status. This goal was only possible through cutting staffing levels further and using healthcare assistants instead of nurses.

It also found evidence that this drive to save money also meant that the hospital wards were reconfigured in an untested way and concerns from staff about this new arrangement were neglected.

Some disturbing incidents were recorded:

  • Basic observations regularly went unrecorded
  • Calls for help to use the bathroom were ignored
  • Patients were left for hours in soiled sheets
  • Food and drinks were left out of reach
  • Family members were asked to help with feeding and personal hygiene
  • Patients went unwashed – sometimes for up to a month
  • Standards of ward cleanliness were extremely poor
  • The report also strongly criticised regulators at all levels of the NHS and said they had ‘failed’ in their duty.

Despite all the shocking findings Francis decided that Stafford Hospital should not be closed. He said that, while there is a lot of work required, the new management team has made a successful start. He additionally provided 15 specific recommendations for the Trust.

What does it mean for junior doctors?

The Francis Report will have wide ranging implications across the NHS but it will likely take many years to have an effect. There are three ways it may impact us as junior doctors:

1. Duty of candour: The report says that all healthcare organisations and staff must be open and honest with patients. This means information must not be hidden or withheld in order to protect individuals or the organisation. It also says that gagging clauses stopping staff from speaking out should be prohibited.

2. Training: Francis outlined some key recommendations for training of all healthcare professionals. He said that no-one should be working in the NHS without registration and called for stronger training in patient experience for nurses. For doctors, the GMC has already announced it will increase the role of quality and safety training in the undergraduate and postgraduate curriculum.

3. Complaints: Francis recommends that complaints to regulators on provision of care which have been upheld should be published on the NHS organisation’s website along with the response.

Further information

Mid Staffordshire NHS Foundation Trust Public Inquiry website –

Francis Inquiry – Lessons from Stafford –