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Network/Syngentis response to Francis Report


Dear Sir

Re: Response to the NHS Confederation consultation ‘Making it better – Assuring high-quality care in the NHS’

This response is from NHS Health at Work Network, the body that represents occupational health teams providing health and wellbeing services to NHS staff, and Syngentis the not for profit health and work community interest company that has ben set up to progress the work of NHS Plus. 

Our response relates to many of the issues raised in your discussion paper and specifically addresses your question: ‘Creating a positive culture is vital to ensuring patients receive good quality care – How could organisations be encouraged to develop a positive culture of leadership, learning and improvement? Who should lead this?’

We believe that after the events of Mid Staffordshire the NHS must prioritise staff health and wellbeing. Staff who feel nurtured, valued, and are healthy are more likely to buy into NHS core values and be motivated and committed to improving patient care. 

The Francis report is calling for cultural change. Occupational health plays a key part in contributing to cultural change.

Leaders of the most successful and high performing companies know that ‘the quality of service that reaches the customer (patient) begins with the quality of service that staff give to each other’. 

Research shows that engaging your staff is the single most important action a leader can take to positively influence patient care. There is good evidence that access to good occupational health support improves staff engagement and therefore has a direct impact on patient care.

NHS staff work in difficult and complex conditions that are full of risk. To be effective we need to recognise, value and reward the contribution made by staff and ensure that they are healthy, well and looked after. 

Where NHS organisations prioritise staff health and wellbeing, performance is enhanced, patient care improves, staff retention is higher and sickness absence is lower.

In Mid Staffordshire, early warning systems were immature and ineffective. Occupational health is in a unique position as part of the interface between staff and managers. Occupational health can therefore be part of the ‘early warning system’, and alert managers when staffs are experiencing problems and if they believe a blame and bullying culture pervades. 

Medical Directors have a key responsibility for monitoring the performance of all Trust medical staff. As ‘Responsible Officer’, it is their role to identify and address performance concerns. Occupational Health Physicians, with their expertise in understanding the relationship between health and work can support Medical Directors in discharging their responsible officer role, ensuring appropriate care for staff and managing the risk to patients.  

Managers have the key responsibility for creating a stress free culture, identifying and tackling the causes of stress and for ensuring that the people who work in their team feel supported. However occupational health can help those employees who experience stress and work with managers to ensure them that are aware of stress within their teams.

Employee health and well being influences whether people are able to work at their peak and are critical success factors for individual and organisation performance. NHS occupational health services play a key part in enhancing and maintaining the health of NHS staff so that they can deliver the best possible patient care.

Jeremy Hunt said the response to the Francis Review marked the start of a "fundamental change to the system" and that "We cannot merely tinker around the edges - we need a radical overhaul with high quality care and compassion at its heart.” Occupational health services should not be seen as an ‘add-on service’ but an integral part of that radical change. They should play a pivotal strategic role in addressing the overall health and well-being of staff.

Occupational health services therefore need to be adequately funded and resourced so that they can play their part in implementing the recommendations in the Francis Report. Far from ‘diverting funds unnecessarily from front-line care’ this will save money by making a significant contribution to staff productivity and reducing sickness absence. More importantly it will be a significant step in creating a positive culture and improving the quality of care for patients.

The NHS Health and Work Network looks forward to supporting the NHS Confederation and the NHS more generally in taking forward the action resulting from the Government’s response to the Francis Report. If you would like to contact us please email

Yours faithfully

Dr Anne de Bono 
Chair, NHS Health at Work Network

Professor John Harrison

Director, Syngentis (the health and work community interest company progressing the work of NHS Plus) 

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