I subscribe to an NHS managers e mail newsletter / blog.  Roy Lilley is most often the writer – and anyone with an interest in the NHS and its management can subscribe (go to www.nhsmanagers.net)   As someone who works with many different people within the NHS and who are suppliers to it, I find it very useful, interesting and deeply upsetting sometimes.

The Francis report is forensic and detailed (nearly 4000 pages with 290 recommendations).  I quote from today’s e mail – written by Professor Brian Edwards:

“Much of what Francis says makes sense but one wishes he had stuck to the big issues rather than chase down every detail, with a lawyer’s instinct.

It is I am afraid a full week’s read for everybody. Expect dozens of Department of Health working parties and expert groups”

And therein lies the problem.

When so many suggestions are made, everyone can point at someone else, and hide behind a working party or two.  At least some big ideas are there.  No more wholesale changes to the NHS – it stops people doing their jobs.  Good!

The very first recommendation is that patients must come first with care delivered by caring, committed and compassionate staff working within a common culture. 

Are you amazed that this needed to be stated?  When did we think filling in a form to say why you hadn’t done what you were supposed to do was better than doing what you want to do as a caring and committed human being?  It could be you in that bed!

So we have more potential for managers hiding away, and not taking responsibility.  Or measuring the wrong things.  Or sacking whistle blowers.  I have three simple recommendations.

1.  Incentivise whistle blowing – but sack malicious accusers
2.  Have a medical majority on all Boards
3. All board appointments should be for three-year terms and all staff should vote for who should be board members

“In the shadow of the Leader” is a very useful concept to apply to most organisational problems – and positives.  The whole sorry episode looks like a failure of management who showed a complete lack of leadership.  End of.  Heads should roll – and lets stop pointing at the workers first!