The Francis report is a shocking read, and leaves no illusions that the then management of Mid-Staffordshire Hospital put the books before the care and safety of patients. Indeed, it is questionable whether some of these managers should continue to have roles in the NHS.
It also criticises the regulation. For the situation which led to this mess, we need look no further than one Alan Milburn, Secretary of State for Health between 1999 and 2003. Prior to 1999, the NHS had a system of Community Health Councils in place, who were independent of hospital and health authority management and were set up to represent the interests of the local community. The CHC's turned out to be watchdogs with bite - an annual "national" survey of A&E departments made the news headlines and proved embarrassing for whichever Government was in power and NHS managers. They also questioned the wisdom of many NHS re-organisation schemes. Milburns solution for dealing with these watchdogs was simple, push through their abolition, pass some duties onto local authorities and others to a "Patient Advice and Liasion Service" at each trust (and straight away one can see a conflict of interest in this set up, given that local councillors serve on many NHS Trust boards, and the PALS are facilitated by the organisations they are supposed to scrutinise).
Between 2002 and 2010, the system of regulation also kept being changed, and has become more and more remote from patients and service users. How many people have heard of the "Care Quality Commission"? How many people have any idea about what it does? Why is there a top down quango looking at the financial performance of NHS Trusts, rather than the job being done by the Department for Health? How many people are aware that local authorities have a role in scrutinising healthcare - (and I suspect while some like Birmingham have done a good job, others have given little attention to this role. Francis pointed to the lack of inquiry and investigation by the Staffordshire local councils).
I would contend had the the Mid-Staffs CHC remained in place, then the appalling care would have been picked up a hell of a lot earlier and that lives would have been saved. For dismantling effective regulation and scrutiny in the interests of making life easy for government and NHS managers, precipitating this scandal, Alan Milburn deserves nothing but contempt and should never be allowed anywhere near a role in public life again.
Meanwhile, whilst Andrew Lansley has presided over another top down re-organisation of the NHS the issue of local regulation and scrutiny has not been addressed - and of course with many local NHS services facing possible transfer to private and third sector providers the ingredients for another scandal are there. The next NHS Bill - which must be due to come in very quickly following the Francis report, must ensure local oversight and accountability are beefed up to ensure the interests of the community come before those of managers, staff, politicians and corporate interests.