The Francis Reports

What Are The Francis Reports?

Robert Francis QC is a Barrister specialising in medical law, including clinical negligence claims. With this expertise, he led a public inquiry into the poor care at Mid Staffordshire NHS Foundation Trust between 2005 and 2009.

The investigation looked into why organisations responsible for regulating and managing the trust did not spot problems before they were brought to light by the campaign group ‘Cure the NHS’.

Healthcare Commission Report

The Healthcare Commission report exposed appalling treatment and high mortality rates at the hospital and concluded that an estimated 400 to 1,200 people could have died unnecessarily there between 2005 and 2008.

Recurring problems emerged, such as:

• Call bells going unanswered
• Patients left lying in their own urine or excrement
• Food and drink left out of reach of patients
• Patient falls being concealed from relatives
• Too few consultants and nurses
• Poor communication between staff and relatives of the patients

What Did The Francis Reports Find?

The First Francis Report

The first Francis report, published in 2010, cited “historic understaffing” of nurses as one of a number of reasons for poor care. Wards were re-organised without necessary risk assessments leading to patient care being compromised.

The ratio of registered nurses to healthcare assistants dropped as low as 40:60 in some areas. Francis specifically criticised the trust for being obsessed with obtaining foundation trust status and meeting targets rather than patient care. At the heart of what happened at Mid Staffordshire Foundation Trust was poor nursing care.

The Second Francis Report

The second Francis report, published in 2013, looked at how the set-up of the entire health and social care system in England can help or hinder nurses and other staff to deliver good care. It also focused on the culture of the NHS and its impact on the ability of staff to raise concerns.

What Recommendations Were Made?

The report made over 200 recommendations in relation to:

• Staffing levels and skill mix
• Protection of whistleblowers
• Eradication of the blame culture and bullying
• Training and regulation of healthcare assistants
• Recruitment, training and standards of registered nurses.

Response To The Report

• GMC. The GMC responded to their progress following these recommendations in October 2013 – this included an insight into education, safety in the practice environment and information sharing.
• Government. At the end of 2013, the government also responded to the recommendations of the report. It included actions for improving patient care: increasing openness and changes to regulation in hospitals.
• NICE. NICE was also asked by the Department of Health and NHS England to create guidelines on staffing capacity to ensure safety in the NHS.

Interview Questions

Thoroughly understanding the key issues of the Francis Reports enables you to have a prime example to refer to when answering ethics questions and teamwork questions during your interview. Some example questions you could be asked include:

• Why is teamwork so important in healthcare? Can you give an example of where a lack of teamwork has caused problems?
• Why do you know about the Francis Reports and what impact did it have on UK healthcare?

Our Interview Question Bank has over 100 other questions and answer guides for you to check out.