Because the protest group, Bill Cash, and the press remained unsatisfied with the HCC report, the Colin Thome report, The Alberti report and the Case Note review, there was continued pressure for a public Inquiry. This was resisted by Alan Johnson, but when Andy Burnham took over as SoS David Kidney was able to persuade him of the need for an Independent inquiry.
The Francis report heard detailed evidence from many patients and relatives and from some staff. Many people felt able to take part in this because it was not conducted in public, and the evidence that was collected was very powerful.
What was immediately apparent to anyone reading this report is that the focus of problems was not on some disastrous breakdown of medical care or widespread medical accidents, it was about basic nursing. It begins with a graphic chapter on continence, and goes on to look at a range of dignity and comfort issues that have since become familiar to us with numerous reports conducted throughout the country.
These are distressing problems. They are also very familiar to people who have had any dealings with hospitals or care homes over the last few decades.
Robert Francis also clearly identified that the excess death figures were unsafe, He gave introductory details of the major disagreements between the proponents of different statistical systems for measuring mortality and he recommended a major review of the way in which mortality statistics are collected.
Robert Francis recommendations have been taken seriously by the health profession, and much quiet careful work has been going on to address these problems.
It is unlikely that Structural reform of the health service has much to offer, and it is also unlikely that there are any magical solutions on offer. The problems are deep seated. They are about our willingness to pay for the care we all need, and about some of the attitudes to the elderly and vulnerable that permeate our society.