People still write to Sir Robert Francis with desperate pleas for him to help them get justice from the NHS. Sometimes he even intervenes where he can.
NHS staff too find ways to contact the 72-year-old barrister with shocking stories of poor care in the health service, and they tell him how managers still pressure them to keep quiet about it.
“Just yesterday, I was told of a hospital where a gentleman was left in a chair with a broken hip for 22 hours without treatment, because there was nowhere else to put him.
“I have had senior clinicians in tears about their inability to treat people properly in A&E and not knowing what to do about it. The system is collapsing around our ears,” said Francis, who 10 years ago this week published the landmark report into the scandal at Stafford Hospital, where hundreds of patients were neglected between 2005 and 2009.
The weight of patient stories he heard in harrowing detail has taken a toll.
“I think about it virtually all the time, with this sort of sense of hopelessness about what can be done. There is this sense that people are dying out there.
“I have felt, over the years, the inability genuinely to do anything to help people who clearly need help.”
In his damning report, Francis found that patients at the Mid Staffordshire Foundation Trust were left unwashed, unfed and often forced to lie in soiled beds for hours. Vital medications weren’t given and some nurses treated patients cruelly, with wards left in filthy conditions as a result of short staffing. The trust management had put targets, finances and corporate self-interest ahead of patient safety, he said.
But his report didn’t just criticise the hospital. As a public inquiry, it delved deep into how the regulators, civil servants and politicians fuelled the care disaster, exposing how almost every level of the NHS failed to spot what was happening. Francis described a top-down culture and a Department of Health and Social Care “remote from the reality of the service at the front line”.
Now he fears what progress there has been made on safety in the decade since is being derailed by the pandemic and huge pressures of demand on the NHS, which he says is still too defensive and top-down.
“One of the principal things that went wrong at Mid Staffs – everyone talks about targets, and of course, that's right, there was a focus on targets – but the real issue was that no one listened either to the patients or to the staff. And I'm not sure we've made very much progress on that.
“The complaints I hear are that the culture within NHS England has not changed very much over the years and is still whatever the board wants. There's still a lot of top-down, control-and-command type stuff happening, with chief executives feeling they're being persecuted.”
One of his main concerns is the current treatment of NHS staff. “There is hardly anywhere where the staff are properly looked after in terms of their wellbeing, health and basic welfare, such as food and drink. They have to go on strike to get listened to.”
With a week of strikes this week by nurses and ambulance staff, Francis called for talks over pay between unions and ministers or else patients would pay the price. “Negotiation should be happening rather than just deadlock,” he said.
Hundreds of extra deaths a week have been blamed on long delays in A&E departments during the past 18 months.
During the Mid Staffs inquiry, one junior doctor – Chris Turner, now a consultant in Coventry – told the hearing that the A&E department at Stafford Hospital had been “immune to the sound of pain”.
Now in 2023, Francis said the situation was being replicated. “I think staff are hearing the pain now and they can't stand it anymore and they're leaving.
“Or they are becoming immune and not listening. The pressure on the human beings who provide the service is such, from top to bottom in any given organisation, that inhumane things are bound to start happening and are happening on a much wider scale than we had at Mid Staffs.”
He said NHS trusts needed to examine how they could make the lives of their staff better, irrespective of pay.
Francis said fundamental changes were now needed to the way care is organised and delivered, and that would need a big conversation with the public about what that could mean.
He also still holds to key reforms he wants to see implemented to try and improve culture and safety.
These include listening and involving patients fully, not just in complaints, but in the investigation of incidents and honesty about what has happened. This is better than in 2010 he believes, but still too inconsistent.
He said NHS managers should be regulated in line with proposals in a report by Tom Kark KC in 2019, which called for competency checks and an ability to strike off those guilty of misconduct.
In line with this, he said the voice of nursing leaders was too weak and not given the respect it deserves. “I think it's absolutely vital that there is a professional voice of nursing, which is listened to in relation to standards, which is distinct from the trade union.
“It was a problem at Mid Staffs that the nursing voice was not heard. I think chief nurses do not have the status they should do and the chief nursing officer does not have the status she should.”
He added there was “general pressure on national leaders to toe a line rather than expressing an independent voice”.
Other changes he backed are making it a criminal offence to block whistleblowers raising concerns, and for civil servants at the DHSC doing shifts on the front line, which was in place immediately after his inquiry.
“I think they should reinstate that. I think it's very easy for people in the Department of Health to forget why they are there, and a lot of what happened with Mid Staffs was because people stopped thinking about the impact of policy.”
Francis, who became a barrister in 1973, and a Queen’s Counsel in 1992, warned during the Mid Staffs inquiry that if the NHS did not improve it would be overwhelmed by a “tsunami of anger” from patients.
More than a decade on, his frustration is aimed squarely at the failure of those in political positions to take action over known issues.
He said: “The anger will come with not one incident or two, but large numbers of incidents reported of people being found dead at home, left in chairs in A&E for 22 hours or who haven't been fed for 48 hours. If you get enough of those, you get a tsunami of anger and it will be directed at the politicians.”
Shaun Lintern is Health Editor of The Sunday Times.