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Francis is a wakeup call for everyone. As Mark says no one profession comes out well. We got to move away from 'them and us' culture, blame culture and bullying culture. We are all in this together.

NHS needs 'Fair and Open' culture, supportive and learning culture and an accountability for all including the Trust Board members. Patient safety is everyone's business and everyone's duty. Leaders should walk the floor, mix with their staff, listen to them and their concerns, see what goes on at the level of patients in the beds, A&E, theatres and talk to both patients and staff regularly. Sadly most leaders sit in their ivory tower and expect things to run smoothly at the level of patients.

Most staff come to work to do a good job and it is our systems which make them what they become. Organisational culture, leadership and energy are the key to the success or failure of any organisation.

If the culture, leadership, governance systems are good and robust then poor behaviours and poorly performing staff are identified early and they can be helped and supported and if not removed. Sadly, NHS always looks for scapegoats and individuals rather than looking at the whole system. In a poor system and poor culture and poor leadership, bad behaviours are tolerated, sub-standard treatment is accepted and even simple basic humanity and dignity is forgotten and patients simply become targets and numbers.

The most important thing is to look at the organisational culture, leadership, governance, quality assurance systems and patients and staff feedback survey. Every leader must be performance managed and should have feedback
from those who are affected by their leadership.

Leaders must have the courage to challenge those who provide sub-standard care and poor behaviours.