Francis report: Jeremy Hunt has prioritised blame over support

Francis report: Jeremy Hunt has prioritised blame over support The government's response fits in with the wider political strategy of blaming individuals for shortcomings in the system.

2013 has been quite a policy year for NHS care standards – there has been the Francis Report, the Keogh and Berwick reports, Cavendish on support staff, Clwyd on complaints, and the government'sfinal response to the 290 Francis recommendations.

The latter runs to almost 400 pages over two volumes. What have we got to show for it? The answer is a raft of solutions largely modelled upon a marketised view of the NHS in which "consumers" are "empowered" and a failure regime is in place to deal with "imperfections".

Listening to and supporting patients and helping them to exercise choice are all prominent themes. Much of this was already in train, such as the extended use of the Friends and Family Test, more prominence for the NHS Constitution and acting upon the Clwyd recommendations on strengthening the complaints system.

New proposals are for a hospital safety website – ambitiously aimed at "putting the truth about care at the fingertips of patients" – and the creation of an army of 5,000 patient safety tsars within five years. These are helpful, though not game-changing, measures.

The thrust of the new measures is towards regulation of activity and criminalisation of breaches of behaviour. There are a wave of proposals including a new duty of candour on provider organisations (but not individuals) to tell patients about medical errors – and a threat to remove indemnity cover if the rule is broken; more robust inspections by the Care Quality Commission; new barring regimes to determine if board directors of NHS provider organisations are "fit and proper persons"; and new criminal offences of wilful neglect and the provision of false or misleading information.

Spurred on by lurid headlines about "50,000 too many people" dying under Labour governments, this will doubtless strike a chord with the public. It also fits in with the wider political strategy of blaming individuals for shortcomings in the system – people without jobs failing to look for work, people with disabilities holding the wrong mindset, people with too many rooms who are selfish. Now we can add NHS staff who simply don't care enough.

The other problem here is not so much what is in the government's response; but what is left out. The key omissions are around participation and support. The Francis report had much to say about the miserable record of the NHS in its relationship with local people, observing that the high tide had been reached with Barbara Castle's Community Health Councils, which Labour abolished in 2003.

His proposals on strengthening the role of foundation trust governors, improving public and patient participation in Monitor and strengthening the role of Local Healthwatch have all been downplayed. Notwithstanding recent guidance from NHS England on improving public and patient engagement the reality is that local people – individually and collectively – have little or no say in how their healthcare is commissioned and provided.

The greatest omission, however, is an offer of support – as opposed to exposure and regulation – to NHS staff. The government seems to have largely turned its back on Don Berwick's advice to "abandon blame as a tool" and "make sure pride and joy in work, not fear, infuse the NHS". The registration of untrained Health Care Assistants, as recommended by both Francis and the Health Select Committee, is rejected along with legal protection for the whistleblowers who put their careers on the line.

More significantly and predictably, the government has sidestepped the need for adequate levels of staffing, both in terms of volume and skill-mix. Rather than set legal minimum requirements, hospitals will be told to use evidence-based tools to decide for themselves what staffing levels to use, and to publish twice-yearly figures to show they have met these standards.

Even the measures that are being proposed will have considerable cost implications.

Hospitals will be saddled with more targets and reporting requirements at a time when much of their administrative infrastructure has been abolished. Around 7,000 nursing posts have already disappeared since 2010 but somehow hospitals will be urged to meet new staffing levels. In the meantime, most trusts are being financially crucified by 4% per annum efficiency savings, PFI repayments and crippling tariff rules on delayed discharge, emergency readmissions and accident and emergency services.

What we are left with is an imbalanced response to the issue of harm-free care – one that prioritises blame and recrimination over learning and support, inspection over participation and the imparting of information over accountability to local people. Failure will be perpetually in the spotlight, successes rarely exposed and celebrated. But maybe – just maybe – this is exactly what Jeremy Hunt has in mind? Guardian Professional.