Francis 243 – 0 Hunt: NHS staffing, wilful ignorance – and a plan


Jeremy Hunt’s announcement in Parliament last Tuesday on the changes he is planning in the wake of the Francis Report into events at Stafford Hospital was remarkable for two things: the complete absence of the key factor that Robert Francis identified as being at the heart of the poor care at the hospital and as clear a case of “giving away the ‘master’-plan” as you will ever see.

Or not wish to see, since for all Hunt’s timorousness and petulance it will be an absolute disaster for hundreds of thousands of people.

The problem that never was, or ‘out of sight, out of mind?’

Hunt prefaced his announcement of his measures by genuflecting before the altar of the Francis report:

I also pay tribute to Robert Francis QC for his work in producing a seminal report that will, I believe, mark a turning point in the history of the NHS…Our actions must ensure that the NHS is what every health professional and patient wants: a service that is true to NHS values, that puts patients first, and that treats people with dignity, respect and compassion..The Government accept the essence of the inquiry’s recommendations and will respond to them in full in due course.

Always good to make a show of piety. Unfortunately, as we’ll see, Hunt’s devotion to Robert Francis’ is mere lip service for form’s sake – and for the sake of a goal which has nothing to do with putting ‘a service that is true to NHS values, that puts patients first, and that treats people with dignity, respect and compassion.’

Hunt then goes on to list the 5 ‘key’ areas that he is addressing, based on the Francis report – a list in which something is conspicuous by its utter absence. Let’s take a brief look the areas he did mention, quoting his own (weasel) words:

  1. preventing problems from arising by putting the needs of patients first
  2. detecting problems early
  3. taking action promptly
  4. ensuring that there is robust accountability
  5. leadership.

Can you see what’s missing? Here’s a clue.

Francis 243 – 0 Hunt

In the three volumes of his report and his executive summary, Robert Francis mentions a certain word no less than 243 times. That word is:


That’s 243 mentions of that exact word, broken down as follows:

Executive summary: 11
Volume 1:  82
Volume 2:  117
Volume 3:  33

That is not counting the various mentions of similar terms referring to the same issue, such as ‘staff levels’, staff numbers’, etc which would take the total far higher. 243 mentions of that particular word:


Jeremy Hunt paid tribute to Mr Francis for his work and the report that resulted from it. He said the government accepted the report. He said the government would act upon it.

How many times did he mention ‘staffing’ in his announcement?


Yes, zero. None at all. But perhaps he just didn’t use that term – perhaps he said ‘staff numbers’, or ‘complements’, or just ‘numbers’, or some other variant?

How many times did Mr Hunt refer to staff numbers in any way during his speech?


Hmmmmm. Do you get the feeling that there’s a subject he wants to steer clear of?

In every single one of his five ‘keys’ that will ‘mark a turning point in the history of the NHS‘, the notion of understaffing is conspicuous by its absence. What we get instead is a series of measures designed to give the impression of doing something popular (and largely impractical) while actually leading toward an ulterior motive that’s been common in almost every action of the Tories in government toward the NHS.

Here’s how Hunt elaborated on his 5 ‘action points’:

Prevent problems arising by putting needs of patients first

According to Hunt,

people have suffered on such a scale and died unnecessarily


To prevent problems from arising in the first place, we need to embed a culture of zero harm and compassionate care throughout the NHS

I have news for Mr Hunt. ‘Zero harm’ is already deeply embedded in the culture of NHS workers, from doctors’ vow of ‘first, do no harm’ downward. But if hospitals are seriously understaffed, the best intentions and efforts are doomed to fail often. But Mr Hunt knows that and isn’t unhappy about it, as we’ll see.

To achieve this ‘new’ culture, Mr Hunt proposes to make would-be nurses work as health-carers for a year in order to get funding for their nursing degree is deeply impractical and a way to provide cheap cannon-fodder to those hospitals who can afford it. Impractical because many hospitals are not going to be able to pay an influx of additional health-care assistants, so places will be in short supply.

Unless of course, he expects them to work for nothing – which wouldn’t be very surprising, really. No, hands-on caring should be part of nurses’ training, like it used to be – not a prerequisite for getting on a course in the first place.

Detecting problems early

Hunt said,

the most important thing that the country should know is that when it comes to failures in care, the buck stops in one place

Well yes, Mr Hunt. Except it should be the Health Secretary.

Instead, Mr Hunt has decided to create a new ‘Chief Inspector of Hospitals’ – which fits perfectly with the Tories’ love of devolving blame. No amount of inspection, though, will allow nurses and doctors to do more than is humanly possible. The Health Secretary is imposing an official to to detect failure without addressing the core reason identified by Robert Francis for poor care.

‘Setting up to fail – and making more sure failure is caught’, in other words. Which leads us to the 4th – and central – measure Hunt outlined.

Take action promptly

Hunt said,

The problem with Mid Staffs was not that the problems were unknown; it was that nothing was done.

The problem with this is that, although it’s part of the popular perception fostered by the media, it’s simply not true. Martin Yeates, the former chief executive of Mid Staffs, instigated a series of checks that ensured that if Doctor Foster Intelligence alerted them of any increase in death rates, cases were reviewed by other doctors to make sure there were no issues. Two surgeons were removed from their posts because of poor technique uncovered.

But Mr Yeates was forced to step down – by the rage and furore surrounding issues that he was taking steps to address – to the dismay of staff at the hospital who could see that he was doing a good job.

Hunt went on,

No hospital will be rated as good or outstanding if fundamental standards are breached, and trusts will be given a strictly limited period of time to rectify any such breaches. If they fail to do that, they will be put into a failure regime that could ultimately lead to special administration and the automatic suspension of the board.

Ah, now we come to the nub. Hunt has tried to be subtle, but in fact he’s given away his game like a poor poker-player. Hunt is trying to dress up his ‘turning point in the history of the NHS‘ as a plan constructed for the good of the NHS’ patients and potential patients. But it’s nothing of the sort.

What it is is quite simple, really:

  1. Ignore the central cause of poor care in the NHS, leaving hospitals underfunded, under pressure and understaffed.
  2. Appoint an inspector to make sure that the resulting, inevitable failures are identified more quickly and are ‘shouted loudly’.
  3. Take action. Action to address funding and staffing issues so that people dependent on a failing hospital receive better treatment? Nope.

Mr Hunt is going to ‘save’ the NHS, and ‘save’ the people who depend on hospitals, by giving them a short time to solve their problems without the remotest hope of the means of doing so – appointing more staff. And then he’ll put them into ‘failure regimes’ and administration.

Instead of having a struggling hospital, local people will have no hospital at all, as the one they’ve relied on is shut down, or broken up and absorbed into other, more distant hospitals or bought up by private health companies.

Just ask the people of Stafford what that feels like. While you’re about it, ask them whether they feel ‘saved’ by what’s being done to their local hospital and services – and why thousands of them are signing petitions, protesting, delivering leaflets and appealing to politicians and lawyers to help them genuinely save their hospital.

He marched them up to the top of the hill..

Mr Hunt’s 5th point was leadership. But ask any general what his chances of success are if he’s starved of the weapons and materiel he needs to fight the battle. By wilfully ignoring the most crucial issue identified by the Francis report and doing nothing to address the staffing shortages and the funding issues that create them, Hunt is merely setting up the NHS to fail, ensuring failure is punished by counterproductive measures – and leading the NHS into a dead end where it can be picked off, piecemeal.

The blueprint

As I predicted a month ago, the Tories see Stafford as an opportunity and a blueprint. Stafford hospital has been turned around completely and is now among the best district general hospitals in the country – and is about to be closed down, unless its local people are able to save it against the odds.

In his speech, Hunt said,

I want Mid Staffs to be not a byword for failure but a catalyst for change

Stafford could actually be the blueprint for a big, positive change in the NHS – a blueprint titled ‘How to turn around a struggling hospital’ – but that opportunity is being thrown away by the plan to break it up.

Instead, Hunt plans to use the same ‘identify, target, denigrate, close‘ model that has been used to attack Stafford to attack other hospitals – and has targeted 10% of England’s hospitals for his first phase.

Hunt called what happened at Stafford

a betrayal of the worst kind

But it wasn’t – there’s a far greater betrayal couched in Hunt’s words and intentions. A betrayal that involves taking away people’s cherished, vital hospitals – and telling them that he’s only doing it for their good. A betrayal that dresses up a plan to inflict deadly wounds on the NHS that will lead to many deaths and much misery as one motivated by the desire to improve people’s lives and health.

A betrayal that knows exactly what is needed to address the problem – and ignores it completely.

Francis 243 – 0 Hunt.

Don’t forget.


  1. Well said Steve.
    So much of what went wrong at Stafford & elsewhere comes down to staffing numbers but the wilful refusal to ensure wards have sufficient staff to cope tells us all what we need to know – that theis govt are determined to run the NHS into the ground so it can be picked up for a song by the private sector who of course, has the aim of maximising profits before patient care.

    What a mess & it’s not stopped there. I trust you are looking at the situation in Leeds too – there’s a really nasty smell about what’s going on there & far too convenient that Bruce Keogh decides it’s unsafe (on untested data!!) just one day after the closure consultation has been deemed illegal at the High Court.

    Keep at it & may I suggest you tweet Krishnan Guru-Murthy (@krishgm). He & Jane Deith did a piece on Channel 4 yesterday (available on catch-up http://www.channel4.com/news/catch-up/) & they showed an email from John Gibbs (who collected the data) that made it very clear that the data was untested & should not have been leaked by Roger Boyle.

    Channel 4 is the only mainstream media that might be interested in what you have to say. ITV & the BBC seem only to be interested in toeing the party line despite the lies the party are peddling.

  2. Reblogged this on patricktsudlow and commented:
    Under successive Governments, Labour and Conservative, the NHS has been slowly privatised and had staff numbers reduced. The politicians have failed the NHS and the people of England and Wales.

  3. How come so much credence is given to Dr Foster. I’ve never been able to understand what they do that couldn’t ever be done by a team of analysts at the DH. Cheaper. They use publicly available data don’t they, dress it up and put a spin on it to make themselves look unique and essential.

    1. Indeed! I believe SHMIs are done directly by the NHS, though it doesn’t solve the input issues. Certainly avoids the commercial conflicts though!

    2. Because Foster has monopolised the system, infiltrated the patient groups and the media. Moreover their mascot – Professor Brian Jarman is the medical establishment – being ex BMA president. The DOH has not allowed any tender or competition for any other company to take up the mortality race. Ben Bradshaw historically refused to hold a consultation for the best statisticians to get together to actually calculate mortality.

      I suggested calculation of ward mortality – death numbers as a rough guide plus patient safety alerts. This was ignored. At present, we have no method of collecting local death numbers to determine whether there is a problem on one ward.

      I asked Norman Lamb recently about this but there are no plans to put the mortality calculation contracts out to tender. Sad really because Foster is probably not the most accurate, competent or reliable source of assessment of a Trust.

      Dr Rita Pal

  4. Very good analysis and completely accurate. From my own side, I know that the medical establishment would like to put on a show for the public that ” all is now changed” and that the past is the past. For North Staffs, the problems were exactly how you detail it here – short staffing, underfunding etc etc and none of this was ever resolved or admitted. Indeed, the NHS Executive locally went to great lengths to deviate attention to these problems and focus them on say me or whatever else that suited them at the time.

    Midlands Executive knew of all the problems you detail in their local hospitals as far back as 1999. They did nothing to resolve it, neither did they admit to it. When they speak of a change in culture, I note they don’t admit to changing themselves and their short-sightedness. The real problem lies with DOH – where the culture of incompetence has never changed.

    Dr Rita Pal

  5. Yes I think you may be right. The “one-off-basket-case” theory applied to Stafford Hospital to get the DoH off the hook does seem to be crumbling, albeit slowly. If they REALLY wanted to learn from the Mid Staffs experience it would be not how to get there (very easy, as lots of other Trusts know only too well) but how to recover.

  6. What an excellent analysis. Totally agree about the staffing numbers at clinical level and that if these are not addressed more such horror stories will emerge.
    Indeed the CQC is beginning to identify inadequate staffing levels and the RCN has long been reporting about this issue on the evidence of nurses working at clinical level.

    Regarding nurse training – recommending that people who want to become nurses to work on wards as healthcare assistants for a year to demonstrate their commitment is ill thoughtout and unrealistic.

    Candidates for nursing are drawn from a wide age range from school leavers to mature students and expecting candidates from either category to work as HCA’s for a year to demonstrate their suitability without a programme with clear objectives to meet at the end of the period is doomed to failure.

    I am assuming that this hands on experience can also be gained in the community – community nursing teams, care homes or nursing homes. It is not clear how they will be paid or will they be expected to work for nothing with the risk of being used as another pair of hands in an already overstretched caring environment?

    Also who will be tasked with supervising and assessing these candidates? Yes the very staff who are already over stretched and already unable to deliver a safe level of care.

    I do agree that nurse training urgently needs to be reviewed and currently 50% of training is already spent in clinical practice. At a time when the government is advocating the return of the apprenticeship model as a way of introducing school leavers and others into the workplace the practical aspect of the course could be adapted to identify not only those who are not suitable but also those who would make excellent bedside nurses?

    At the end of the apprenticeship period they could be rewarded with a recognised qualification which they could later use to progress to a degree or to remain as bedside nurses. Currently those who want to remain bedside nurses but do not have the necessary qualifications nor want to go to university are either lost to the system or become HCAs with little training or recognition and no career progression.

    I do not believe that compassion can be taught and that university educated nurses are any less compassionate.
    However the experience of patients and relatives of Mid Stafford is real and while I applaud most of the recommendations of the Francis report I fear that if people on the frontline are not given the tools to do the job they will be unable to deliver safe care all the time which is the least patients expect.
    By tools I mean employing the right number of people with the right skills for the environment supported by relevant education, training and supervision in an open culture where poor performance and unsafe practices are not tolerated.

    The Francis report emphasises the responsibility of trust boards and managers at all levels of the organisation to have processes in place, properly monitored, to identify and address risks to patient safety early. This must include ensuring that there are adequate numbers of clinical staff with the right skills to deliver care safely.

  7. And what HMGovernments have failed to appreciate over the years is that adequate numbers of appropriately trained and experienced, permanent staff is not only the way to safe, effective and compassionate care but also cheaper!

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