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17.02pm: Pharmaceutical and technology companies are not providing enough evidence to the NHS of their products’ effectiveness, a senior NHS Commissioning Board figure has said.

Clinical director for specialised services James Palmer told HSJ a proposal from the board around patient access to treatments not normally funded by the NHS would mean firms having to do “proper research”.

16.17pm: Some significant news from Unison that came out during the Francis furore yesterday: Unison has accepted proposals to dilute the Agenda for Change pay framework.

Under the proposals, the national framework will be altered to end automatic incremental pay rises, scrap enhanced out-of-hours sick pay, and bring an end to band five nurses receiving two increment rises during their first year after qualification.

15.44pm: The Royal College of Nursing has acknowledged it has “lessons to learn” from the way it handled events surrounding the care failings at Mid Staffordshire Foundation Trust.

The Francis report said the RCN faced an: “Inherent conflict between [its] professional representative and trade union functions.”

15.18pm: The Royal College of Nursing has issued a press release saying 1,700 posts are due to be cut at four of the five trusts due to be inspected by NHS medical director Sir Bruce Keogh.

The RCN said: “The posts are: Colchester Hospital University Foundation Trust (510), Tameside Hospital Foundation Trust (128), Basildon and Thurrock University Hospitals Foundation Trust (218) and East Lancashire Hospitals Trust (873).”

David Cameron announced yesterday that there would be “immediate” inspections of the trusts, plus Blackpool Teaching Hospitals Foundation Trust, because of concerns prompted by their mortality rate statistics.

15.05pm: The Nuffield Trust’s Ruth Thorlby writes about “the failure of the vehicles supposed to convey patients’ voices beyond the hospital”

She says the failure of these bodies “adds a truly Orwellian flavour to the sense of hopelessness described by campaigner Julie Bailey and others when they attempted to flag up failures using the very systems designed to help patients and relatives faced with uncooperative hospital clinical staff and managers.”

14.40pm: BMJ headline: “Doctors must accept some portion of responsibility for events at Mid Staffordshire hospital, BMA says”.

14.32pm: The health secretary and NHS chief executive have written separately to NHS leaders following the Francis report’s publication.

Sir David Nicholson says: “The timing [of the report] could not be more urgent. As we move towards a new healthcare system, the Robert Francis report provides a salutary reminder to us all of what can happen if organisations care more about their statutory roles and processes rather than doing what is best for patients.

“This is a watershed moment for the NHS. We have to seize this opportunity to create not just another set of action plans, but to drive the cultural change in the NHS further and faster, so that the values and principles set out in the NHS Constitution become part of the DNA of every ward and board.

“I will be writing out again in the coming weeks as the Government considers how best to take forward Robert Francis’s recommendations.”

14.31pm: Labout peer Philip Hunt makes an apolitical point on #Francis. He writes: “Issue on Francis Inquiry little mentioned is the cost. His reccs v.sensible but will need lots more nurses so more time for each patient.” ‏@LordPhilofBrum

14.29pm: Non-Francis news. Ealing MP Virendra Sharma calls for a moratorium on A&E closures until the Keogh review of A&E specifications is completed during Commons debate.

14.13pm: Prominent GP Kailash Chand summarises Francis on Twitter: “‏#Francis report has 290 recommendations. I summarise: “put the patient first” & restore #NHS as nation’s precious treasure” @KailashChandOBE

14.07pm: Lewisham MP Joan Ruddock raises point of order about Jeremy Hunt’s statement to House on the Lewisham A&E/100 lives claim, part of debate on A&E closures.

13.47pm: The Centre for Workforce Intelligence divides the 290 recommendations in the Francis report into five main areas, considered in workforce terms.

It defines these as:

New fundamental standards of compliance, with clear means of enforcement

Greater openness, transparency and candour

Improved support for compassionate, caring and committed nursing

Accurate, useful and relevant information

Better healthcare leadership.

13.17pm: I’ve been soliciting the opinion of hospital chief executives on the Francis report.

A text from the boss of a large hospital trust: “My god! The regulators are going to need an army to do half of what Francis is recommending.

“While completely agreeing that Mid Staffs was wholly unacceptable and an outrage I wonder whether the recommendations will stifle innovation and creativity. The list is endless and terrifying - governors to contact CQC with ANY concerns? Bear in mind some of my governors create holy hell when a lift is out of order and would be more than happy to share this with CQC!

“I may not have got there yet but I don’t see too much in the report about the role of the whole health economy and its accountability in managing pathways in order to allow providers to deliver quality of care.

“Mid Staffs didn’t happen by itself. We aren’t all Mid Staffs, I feel rather depressed!”.

12.58pm A story on our site today: Francis explicitly calls for a slow-down of the foundation trust pipeline.

To be fair to the NHS Trust Development Authority, Matthew Kershaw (who ran the equivalent part of the Department of Health) people have been aware of the need not to trash quality for some time. But Francis saying it explicitly will see sighs of relief in the boardrooms of about 101 trusts.

NTDA chief executive David Flory said as recently as October getting to an all-FT sector by April 2014 was still the policy.

12.54pm: Robert Harris, director of strategy for the commissioning board, tweets: “Ask yourself : How many times have I turned a blind eye when I needed to do something to avert poor practice occurring? Too easy, isn’t it?” @ProfRHarris

12:37pm: I say the Mail hasn’t outright called for Sir David to resign but there is a two-page spread on his “very lavish liefstyle”. The apper quotes one “senior official” likening him to “A ruthless omnipotent medieval Pope”, which is at least a change of imagery from the “Ex-commie” line in the headline.

12.28pm: Jeremy Laurance of The Independent tweets: “Put quality before budgets says #Francis. But how? Close under-staffed wards & let waits rise? Hard choices ahead:  http://t.co/mKyNRIfL

12.23pm: I’ve been asking senior managers what the duty of candour and introduction of criminal offences might mean, some say it will paralyse the management structures of trusts.

“Is that correct?” I asked. One senior manager emails: “Yes. They can kiss achievement of QIPP and a lot of targets goodbye. On top of natural assertion of concerns by genuine professionals, the ‘awkward squad’ in hospitals (difficult,lazy consultants in particular) will use report to block change, go slow etc and managers will be treading on eggshells.”

12.18pm: It’s not quite the Mail calling for Sir David to resign but the paper’s leader column today says “Isn’t it incredible that nobody has been held responsible - while the man in charge of overseeing Stafford Hospital, Sir David Nicholson, has been promoted to chief executive of the NHS?”

12:14pm: The Institute of Healthcare Management has a pretty unambiguous endorsement of the Francis recommendations. Most interestingly the “duty of candour and legal liability that goes with it.

“We agree that failure to comply should be a criminal offence.”

12:00pm: In some non-Francis news, there is a debate scheduled in the Commons this afternoon about A&E closures. This could see Jeremy Hunt questioned over his assertion last week that NHS medical director Sir Bruce Keogh had told him reconfiguring and reducing the number of A&E units in south-east London could save 100 lives.

The Department of Health has said Sir Bruce had “implicitly” endorsed the 100 lives figure although it was not in his letter to the secretary of state.

The debate is expected after a debate on nuclear power and is expected at approximately 3pm.

11.53am: Allison Pearson writes in the Telegraph:

The Prime Minister was much too polite to demand any sackings. But he did point out that neither the General Medical Council nor the Royal College of Nursing has yet struck off a single person in connection with one of the worst scandals in NHS history. ‘Francis does not blame any specific people,’ said Cameron. ‘He says we should not seek scapegoats.’

“What rubbish! Identifying the men and women who presided at a deathtrap hospital is vital if we are to establish a new post-Stafford order. For example, who are the “two cruel ward sisters” cited by many relatives of the dead? And why should they have the privacy and protection they denied to the vulnerable in their care? Let names be shamed.”

Presumably when Ms Pearson writes Royal College of Nursing she means Nursing and Midwifery Council, which has the power to strike off nurses.

11.47am: Sir David Nicholson talks about the Francis report.

11.44am: A round-up of more Francis news and comment

NHS Confederation chief executive Mike Farrar says the Francis report is not just about changes in the regulatory system. NHS leaders must “learn from the best” about what it takes to empower staff and be more open with patients “than ever before”. We’ve posted a HSJ Podcast and a video of him giving his thoughts on the report.

Jeremy Taylor, the chief executive of patient charity National Voices, has told HSJ that Robert Francis’ recommendations don’t go far enough for patients. Listen to our podcast here.

Mark Birtwistle considers what the options are for the organisation at the centre of the Francis report now it’s been published, Mid Staffordshire Foundation Trust. “However badly let down in the past, the local community in Stafford needs a good local hospital for the future,” he writes. “At present, there is no guarantee this will happen. Mid Staffordshire has been in a kind of suspended animation for the past few years.” 

Away from the Francis report reaction, Michael White has written about the “dramatic paradigm shift to rebalance our thinking” towards hospital closures and downgrades, following the decision on South London Healthcare Trust and Lewisham Hospital last week.

10.58am: The CQC is broadcasting its board meeting live.


10.33am: A bit of non-Francis news, a blunt assessment of the performance of NHS Midlands and East from MPs.

10.27am: The Daily Mail’s front-page headline “Man with no shame” with a big picture of Sir David Nicholson. Sub-head: NHS chief who presided over worst ever hospital scandal insists: I have nothing to be ashamed of..

Earlier this week Sir David apologised “as a chief executive and as a person” for Mid Staffs.

10.17am: The Guardian does not lead with Francis and goes with a side column headlined “Cameron’s remedy for the NHS: target nurses’ pay”. This is a report going in on the line Cameron announced yesterday about looking at performance-related pay. Two-page spread inside has a sub-headline: Francis report calls for openness and honesty to replace managerial cult.

10.15am: HSJ editor Alastair Mclellan has synthesised his thoughts on Francis into a leader here.

10.07am: Telegraph headline: “3,000 more patients have died needlessly in hospital”. They have extrapolated that figure from the five trusts named by the NHS Commissioning Board yesterday as being due an inspection from Sir Bruce Keogh because of their high scores on the summary hospital mortality indicator. Two-page spread on Mid Staffs inside and a half-page covering each of the five trusts. As reported yesterday these are: Colchester Hospital University Foundation Trust, Tameside Hospital Foundation Trust, Blackpool Teaching Hospitals Foundation Trust, Basildon and Thurrock University Hospitals Foundation Trust and East Lancashire Hospitals Trust.

10.03am: The Times goes with “NHS: No one is safe” for a headline, with a subhead “scandal of deaths at Mid Staffs Trust could happen anywhere, report says”. Then a picture of Stafford Hospital and pictures of seven people who died there. Two-page spread inside including an account from an Auschwitz survivor who says “At least in Auschwitz I had friends. Here, [the hospital] I have no one at all”.

10am: Francis round-up of the papers coming in a few moments. As expected a strong showing on the front pages.

9.50am: Good morning, in the final part of HSJ’s series looking ahead to 2030 and the factors likely to influence the leaders of tomorrow, Lubna Haq, writes on how technology is affecting the working environment. The nature of leadership will have to change dramatically if organisations are to harness the benefits and counter the negative effects of increasing digital lifestyles, and technology convergence.

“Lifelong learning and networking are essential and will become ingrained, as organisations will no longer be able to rely on traditional hierarchies and career paths. Leaders must embrace the creativity, curiosity and open minds of those who are comfortable with technology.”