In June 2010 the Government asked Robert Francis QC to undertake a public inquiry into the role that commissioning, supervisory and regulatory bodies played in monitoring the work of Mid Staffordshire NHS Foundation Trust. The request followed his earlier independent inquiry into the failings at Stafford Hospital. This section outlines how Nuffield Trust researchers engaged with the Public Inquiry, and assessed the impact that this painful milestone for the NHS had on hospital trusts.

Robert Francis QC talks about the impact of the Francis Report.

The Inquiry’s final report was published on Wednesday 6 February 2013. It addresses a range of issues of concern to NHS managers, clinical staff and patients, as well as policy-makers and national bodies.

These include the recruitment, training and competency of staff, the regulation of care services, the science of quality measurement, the role of public voice and oversight, and the degree to which those working in the NHS feel empowered, supported and engaged.

We are exploring how hospitals and their boards have responded to the Inquiry and what they are doing to focus on the quality of care in a time of financial austerity

Read our response to the Inquiry’s recommendations, which focuses on those areas where the Nuffield Trust has particular expertise, such as NHS funding, patient-level data, commissioning and regulation.

On 19 November 2013, the Government published its full response to the Mid Staffordshire NHS Foundation Trust Public Inquiry, including new transparency measures for hospital trusts.

The Nuffield Trust issued a statement at the time, supporting this emphasis on openness, but warning that the raft of new measures carried risks of over-centralisation. We urged the Government to look further at the changes needed in central bodies and regulators, as well as hospitals.

The Francis Inquiry and its impact touch on many of the Nuffield Trust’s key research priorities, including the regulation of services, and defining and measuring quality of care. As the anniversary of the Inquiry report’s publication approached, we carried out a project, advised by Robert Francis himself, to examine the nature and scale of the response by acute hospital trusts and foundation trusts.

Through a national survey, we explored how the report’s recommendations had been received at a time of financial crisis and rising demand, and in an increasingly complex regulatory environment. Meanwhile, through a series of case studies of trusts and foundation trusts, we looked to explore in more detail how the Francis report was perceived by a range of board members, clinical and managerial staff.

Our final report: The Francis Report: one year on (6 February 2014), showed how important it had been as part of a move to return quality to the high priority it deserved in the wake of Stafford Hospital.

Leaders in our case study trusts described new ways in which they were seeking to monitor quality, to improve staff culture, and to invest in appropriate staffing.

Yet we also found that trust leaders claimed that they were facing serious challenges, finding it difficult to tackle both the challenge of ensuring safe staffing and the need to make efficiency savings. Some felt that the regulatory and oversight bodies were still behaving in a way which risked supporting a negative and closed culture like the one which had grown up at Mid Staffordshire NHS Foundation Trust.

These issues were addressed on the day of the report’s release at a Nuffield Trust event featuring hospital leaders, including Dr Mark Newbold of Heart of England Foundation Trust, alongside senior regulators like Kate Moore of Monitor, and Robert Francis QC.


At the request of the Inquiry Chairman, the Nuffield Trust prepared several submissions covering some of the matters addressed as part of the Inquiry. These papers were:

  • The structure and organisation of the NHS: this paper provides a brief history of the organisation and structure of the NHS, considers the statutory structure of the NHS, explores the arrangements for commissioning NHS services for NHS patients and examines patient and public involvement mechanisms;
  • The regulation and development of NHS managers: this paper makes a brief examination of the history of NHS management, the nature of the NHS management workforce, and the support and development that has been put in place for managers over the years;

As part of the Inquiry seminar on commissioning, Dr Judith Smith, Nuffield Trust Director of Policy, talks about what we can learn from the different iterations of health care commissioning in England.

In addition to the commissioned work described above Dr Judith Smith, Director of Policy, Nuffield Trust, appeared before the Inquiry as an expert witness. Dr Judith Smith gave expert evidence on the 15-16 November 2010 (click here and here to read the transcripts).

Project outputs


  1. The Francis Inquiry: from diagnosis to treatment

    11 Dec 2013
    Journal of Medical Ethics

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