Following Francis: reversing performance in the NHS from targets to teams

Between 400 and 1200 people died unnecessarily in just four years at the Mid Staffordshire National Health Service Foundation Trust in the UK. Two inquiries carried out by Robert Francis QC, the second one producing a report of 1700 pages with 290 recommendations, have proposed a range of changes to the regulatory framework and legal duties placed on hospitals throughout England. It proposes better warning signals, greater accountability of senior managers and NHS staff facing possible criminal prosecution for non-reporting of clinical error. The report also identifies that the model of performance management dominant in the NHS compounded the already delicate balance between available resources and quality of care such that, “quality wasn’t the organising principle of the NHS, it wasn’t the thing that was driving us during that period”(David Nicholson, NHS Chief Executive. Evidence 28th September 2011, Francis Report).Virtually no organisation emerges from the inquiry with credit except the local campaigns set up by the relatives of the victims.The NHS is now facing a major culture change in relation to performance management if it is to improve outcomes for patients.

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