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Francis: slow down FT pipeline to ensure safety

Robert Francis QC has backed the slowing down of the foundation trust pipeline process in order to “make sure” trusts completing the process are safe.

In an in-depth interview with HSJ, Mr Francis said he was not calling for the full abolition of the foundation trust regulator Monitor. He said foundation trust applications needed to be assessed by one organisation, the Care Quality Commission.

He told HSJ: “The most important thing I’m saying is the assessment of corporate governance and finance that goes on in the FT assessment process must take into account, as one, the quality of care that is being provided, because they are so interdependent.

“The principle of making sure aspirant FTs are delivering appropriate quality of care is essential and should be put into force now, there is no reason why it shouldn’t be.”

Mr Francis said he noted comments by the prime minister that the speed of the foundation trust process “shouldn’t be the governing factor”.

Mr Francis said David Cameron’s comments “would suggest a slowing down of the process”, and he added: “I would support that”.

He defended his decision to increase the powers and responsibilities of the CQC, which was heavily criticised at the public inquiry.

“It’s better to use what you have got and make it work rather than thinking by changing it, with all the disruption that causes,” Mr Francis said. “I think it’s more effective to try and make what you have work.”

He added: “The recommendations I have made for the CQC I hope produce clarity about the standards they have to enforce, about the rigor with which they are to be enforced, including criminal sanctions, and the changing culture that is required.

“The CQC is one of many parts of the system that needs to learn lessons about that and obviously they need to be kept under scrutiny.”

Mr Francis, who has been investigating the failures at Mid Staffordshire since 2009, refused to give views on NHS chief executive Sir David Nicholson and other leaders.

He added: “It is not for me to have confidence in people and not for me to comment on them. I have described what I found and I have asked that everyone involved, included those in the system, reflect on the lessons to be learned.”

Mr Francis said that in drawing up his 290 recommendations, considering “how you pay for this” was not part of his jurisdiction.

However, he added: “I have thought to design the recommendations I have made so that they are not resource hungry and a lot of this is about doing the same work in a different way. It’s about putting patients first.”

He told HSJ: “The NHS mustn’t sit back and expect to be told what to do; it must take responsibility for implementing the recommendations.

“The leopard has to change its spots if the public are to retain trust in the system. To personalise it and say these people have not done well in the past. Just changing people isn’t necessarily the answer. We need leaders to accept the lessons of the report and take the matter forward.”

Readers' comments (3)

  • Surely this must also have an impact on the wave of mergers going on as they will need to make care and patient sense as well as financial and figures sense- to paraphrase the PM. Not sure the normal HM Treasury business case (the clue is in the name) has space for these key issues.

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  • It seems to me that the only freedoms given to FTs is the freedom to harm patients with little monitoring, and a pat in the back for meeting the financial targets. Not sure about delay why not just scrap.

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  • Oops forget! Go to save £20Bn in next two years. Whose idea was that then and what impact is it having on providing high quality care? And what happens to those organisations and their managers who can't achieve it without it impacting on the quality of care? Well they've got to go, haven't they. Attaining FT status (where failure to be an FT is NOT an option) has driven this culture, but taking £20Bn out without a credible alternative system is undoubtedly compounding it

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