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About the Francis Inquiry

The Francis Inquiry report was published on 6 February 2013 and examined the causes of the failings in care at Mid Staffordshire NHS Foundation Trust between 2005 and 2009. The report makes 290 recommendations, including:

  • openness, transparency and candour throughout the health care system (including a statutory duty of candour), fundamental standards for health care providers
  • improved support for compassionate caring and committed care and stronger health care leadership.

We reflected on the year since the publication of the report in our news release and a blog from John Illingworth.

Culture Change in the NHS (11 February 2015)

This report sets out the steps that the government has taken since Robert Francis’ public inquiry into the challenges facing Mid-Staffordshire in 2010. These steps include a tougher inspection regime run by the Care Quality Commission (CQC), new duties to promote openness and a range of national initiatives. While much has changed, the report argues that we cannot be complacent and must ensure that the achievements and improvements made since the Francis Inquiry are sustained and embedded for the future.

Download the report

Freedom to speak up (11 February 2015)

In this report Sir Robert Francis, Chair of the Freedom to Speak Up Review, recommends a package of measures to ensure in future NHS staff are free to speak up about patient safety concerns.

It sets out 20 principles and actions which aim to create the right conditions for NHS staff to speak up. This follows an independent review into creating the open and honest reporting culture in the NHS.

View the report

Infographic: A commitment to act? Progress since the Berwick report (19 November 2014)

We, in partnership with Monitor and the Trust Development Authority, undertook a survey to assess the progress made against the recommendations in the Berwick review, A promise to learn – a commitment to act.

We asked every NHS provider in England about the impact that the Berwick review had in their trust, and what progress has been made against the challenges it identified. 40% of Trusts responded to the survey and we have created an infographic summarising the key findings.

View the infographic

Sign up to Safety (24 June 2014)

On 24 June 2014, the Secretary of State for Health, Jeremy Hunt, launched a new campaign called Sign up to Safety. The campaign forms part of the response to the Berwick Report. You can read the Health Foundation’s response here.

The campaign has a three-year objective to save 6,000 lives and halve avoidable harm. Organisations and individuals can sign up to safety and make pledges to improve patient safety. Organisations are being asked to set out how they will take action to improve safety and reduce harm.

NHS England, Department of Health, Monitor, NHS Trust Development Authority, NHS Litigation Authority and CQC have all commitmented to align their organisations’ work with the campaign, which will be led by Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust. David is also a Health Foundation Governor.

More information is available on the NHS England website.

Response from the government (19 November 2013)

The government has now responded to the recommendations of the Francis Inquiry in Hard Truths: the journey to putting patients first. It includes recommendations for improving patient involvement in their care, increased transparency, changes to regulation and inspection. Read our press release on the government's response.

In its response, the government also responds the Health Select Committee report After Francis: making a difference and to the findings of the six review groups which were set up to explore some of the issues the Francis Inquiry report raised. The review groups reports are available:

Other policy developments


Following the Report of the Francis Inquiry and the Berwick Review into Patient Safety, NICE has been asked by the Department of Health and NHS England to produce guidelines on safe staffing capacity and capability in the NHS. During May 2014, NICE consulted on staffing levels in acute care and in A&E. More information is available on the NICE website.

Nuffield Trust

The Nuffield Trust published a research report called 'The Francis Report: One year on'. The report looks at how hospitals have responded to the findings and recommendations contained in Robert Francis QC’s report.

It found that many of the themes from the Francis Inquiry Report, including the importance of openness, adequate staffing levels and patient-centred culture, have resonated with leaders of the hospitals. However, the research also found that some hospital boards were finding it hard to meet increased demands for assurance and scrutiny from external regulators and commissioners that have arisen since the Francis Report.

National Quality Board

The National Quality Board (NQB) - which brings together the different parts of the NHS system with responsibilities for quality, alongside patients and experts - published a 'Human Factors in Healthcare Concordat' signed by its member organisations and other partners on 19 November 2013. The Concordat can be found on the NHS England website.


In October 2013, the GMC published update on their progress against the recommendations of the Francis report. The work is focused around six main themes:

The Royal College of Physicians

The Royal College of Physicians (RCP) set out its commitment to a series of actions to help realise the recommendations of the Mid-Staffordshire inquiry in their response to the Francis Inquiry.


In Summer 2013, the CQC consulted on a new inspection regime. Read the Health Foundation's response.

Our work

Reducing harm to patients

In this briefing, we reflect on the factors that have contributed to the success of Virginia Mason Medical Centre in the US, and how a similar approach has been used in the UK. It aims to help those working to improve patient safety in the NHS.

Hard truths, essential actions: our analysis of the government's response to Francis

In the light of 'Hard Truths', the government's formal response to the Francis Inquiry, we ask how the NHS should digest and translate the learning and recommendations to create a safer and more compassionate place for the patients it serves. Read our briefing.

Working to answer the question 'how safe is care today?'

In the last decade in the UK there has been a huge volume of data on medical error and harm to patients collected. Despite this, we still don’t know how safe care really is today.

During 2013 we worked with stakeholders to develop a framework about how we can measure and monitor patient safety so we can find the answer to this elusive question 'How safe is care today?'. The framework is proposed by Charles Vincent and colleagues from Imperial College London in their report The measurement and monitoring of safety. We have also developed a practical guide for the measurement and monitoring of safety.

Working to develop proactive approaches to managing safety

At the moment, safety management tends to be reactive and to focus on areas that are easy to measure. This means improvements have focused on reducing specific health care associated harms, such as MRSA, and improvements have only been made after a number of people have experienced poor care.

To improve safety further, a more proactive approach is needed – identifying where things could go wrong and taking action to prevent this happening. Through our improvement programmes we are testing and developing ways to support proactive approaches to managing safety.

Further reading

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