Trust leaders have “formally and publicly” acknowledged that “pockets” of poor care are likely to exist in most NHS organisations, in an open letter ahead of the publication of the Francis report.

The Foundation Trust Network, which shared its letter with HSJ, said it constituted an attempt to “say publicly and collectively what individual trusts might want to say but are unable to”.

FTN chief executive Chris Hopson told HSJ the letter had received “almost universal” support from the 230 NHS trusts and foundation trusts that make up the organisation’s membership.

The letter says there is “deeply disturbing evidence” that in “parts of a very small number of trusts” patients have suffered care failures which can be described as “a form of abuse”. However, while failures on this scale are extremely rare there are “pockets of practice at ward level” across the NHS where the quality of care is “unacceptable”.

The FTN letter states: “We believe it is important that, as a sector, we should therefore now formally and publicly acknowledge that instances of poor practice do exist and that this is a problem that we need to address, own, understand, and tackle together.” 

Robert Francis QC’s report into the failures at Mid Staffordshire Foundation Trust is due published in the coming weeks.

The 10-page letter says most NHS care is excellent but that even the “very best trusts are not immune from failures in quality of care”.

It points to evidence from the Care Quality Commission and others that care quality problems are “not universal” within institutions where failure is found. It uses this to call for scepticism of “diagnoses that explain poor care solely through system level or institutional level failures”.

The report says that any new regulation to protect patients from poor quality care “needs to be kept in proportion to and in balance with other quality drivers”.

The letter acknowledges that lack of resources can be a factor in poor care but describes it as “too simplistic” to suggest a straightforward cause and effect relationship. It highlights academic evidence that has shown “high levels of staff engagement” to be the common factor among health organisations with good quality and financial performance.

Mr Hopson said: “When the Francis report is established there is a big danger, understandably, of there being a really emotional reaction,” he said. “What we are trying to do is say let’s have a careful and balanced debate.”