The Francis report on the failings of the Mid Staffordshire NHS Foundation Trust represents a wake-up call to the whole NHS.

The report is a damning indictment of the whole NHS landscape that existed when the terrible incidents occurred, and to an extent thereafter. This was an NHS obsessed with targets which struggled to cope with the constant demands of reform. Sadly, the welfare of patients fell between the cracks in this particular trust and in others.

The reports of many health regulators, then and today, frequently reveal hospital errors and a patient safety crisis. It is fair to say that an ingrained culture of patient safety did not exist at the time of the events considered in the report, and even today it cannot be said to fully exist. Errors are all too common in today’s NHS.

The Francis report puts forward some very good, commonsense recommendations and does not fall into the trap of recommending root-and-branch reform, which has been all too common in the NHS and was part of the problems identified by the report.

The NHS also has long been a victim of too much reform in healthcare quality regulation and patient safety. Reformers have not had a clear and shared idea of the basic concepts needed to underpin what they have been trying to do. The result has been duplication, over-regulation and health carer disillusion with the regulatory systems. We have had, and today still largely maintain, a reactive as opposed to a proactive healthcare quality improvement and regulatory structure. Improvements have been made, but the situation is far from ideal.

Key legal points from the Francis report are the statutory ‘duty of candour’. Also, that non-compliance with a fundamental standard leading to the death or serious harm of a patient should be capable of being prosecuted as a criminal offence. The NHS Litigation Authority (NHSLA) is mentioned in the report, which states that NHSLA, through its risk-management ratings, has made a contribution to the assessment of NHS provider governance. But the significance of this has been misunderstood and sometimes misapplied. The report states that NHSLA should set more demanding levels for financial incentives, and arrangements should be made for the more effective sharing and recording of information.

Recommendation 95 of the report relates to information sharing. It states that the interests of patient safety should prevail over the narrow litigation interest under which confidentiality or even privilege might be claimed over risk reports. Consideration should also be given to allowing the Care Quality Commission access to these reports. In addition, there is also some discussion about the relationship between complaints and litigation.

Recommendation 110 states that actual or intended litigation should not be a barrier to the processing or investigation of a complaint at any level. The report talks a lot about the NHS constitution and its use to improve patient care.

It will be interesting to see how many of the report’s 290 recommendations are adopted by government. The Francis report, in its consideration of the evidence of more than 250 witnesses and over a million pages of documentary material, creates in itself an important series of health quality and patient safety reform agendas.

Given the complexity of modern healthcare, with its dependence on the human factor, some error will be inevitable. The key is to successfully manage the risk of error occurring. Unfortunately, the NHS management and care quality infrastructure is only making incremental progress towards creating a safer NHS. Much more needs to be done. The Francis report successfully points the way forward.

John Tingle is reader in health law at Nottingham Law School, Nottingham Trent University