The Francis Inquiry: Nuffield Trust analysis and resources

Area of work:

Commissioning, NHS reform, Quality of care, UK & international comparisons

In June 2010 the Government asked Robert Francis QC to undertake a public inquiry into the role that commissioning, supervisory and regulatory bodies played in monitoring the work of Mid Staffordshire NHS Foundation Trust. The request followed his earlier independent inquiry into the care provided by the hospital trust. This section outlines how Nuffield Trust researchers have engaged with the Public Inquiry, and our planned future activities in this area.

^{Following publication of his final report, Robert Francis QC spoke at the Health Policy Summit 2013 where he outlined the main findings and the challenges they pose for those working in the health service.}

The Inquiry’s final report was published on Wednesday 6 February 2013. It addresses a range of issues of concern to NHS managers, clinical staff and patients.

These include the recruitment, training and competency of staff, the regulation of care services, the science of quality measurement, the role of public voice and oversight, and the degree to which those working in the NHS feel empowered and engaged.

Nuffield Trust Director of Policy Dr Judith Smith was an assessor to the Mid Staffordshire NHS Foundation Trust Public Inquiry

Read our response to the Inquiry’s recommendations, which focuses on those areas where the Nuffield Trust has particular expertise, such as around NHS funding, patient-level data, commissioning and regulation.

The paper strongly endorses the Inquiry’s main message that listening to and understanding patients must come first, at all levels of the NHS. But it also warns the Government (in taking forward the quality agenda) of the risks inherent in adopting a ‘big stick’ or punitive approach to the providers of health care.

Background

At the request of the Inquiry Chairman, the Nuffield Trust prepared several submissions covering some of the matters addressed as part of the Inquiry. These papers were:

The structure and organisation of the NHS: this paper provides a brief history of the organisation and structure of the NHS, considers the statutory structure of the NHS, explores the arrangements for commissioning NHS services for NHS patients and examines patient and public involvement mechanisms;

The regulation and development of NHS managers: this paper makes a brief examination of the history of NHS management, the nature of the NHS management workforce, and the support and development that has been put in place for managers over the years;

NHS commissioning – lessons from the past for the future: this paper briefly examines the origins of NHS commissioning and explores its different iterations in the English NHS over the past 20 years;

Training and development for effective boards in the NHS: this paper offers insights into how NHS boards might develop in order to discharge their responsibility for overseeing performance in their trusts more consistently in the future.

^{As part of the Inquiry seminar on commissioning, Dr Judith Smith, Nuffield Trust Director of Policy, talks about what we can learn from the different iterations of health care commissioning in England.}

In addition to the commissioned work described above Dr Judith Smith, Director of Policy, Nuffield Trust, appeared before the Inquiry as an expert witness. Dr Judith Smith gave expert evidence on the 15-16 November 2010 (click here and here to read the transcripts).

Future work in response to the Inquiry

A number of the issues raised by the Inquiry, particularly around the regulation of care services, commissioning, and measurement of quality, are long-standing issues of interest to the Nuffield Trust. Our research programme touches on all of these issues and we will be taking forward various projects that aim to provide new insights in these areas.