Rosaria Butterfield – fascinating new autobiography of a lesbian English professor who finds Christian faith

Rosaria Butterfield is an ex-lesbian English academic and one-time professor of 'queer theory', now married to a pastor in the Reformed Presbyterian Church of North America.

She has written a fascinating autobiographical account entitled 'The Secret Thoughts of an Unlikely Convert: An English Professor’s Journey into Christian Faith' which is just starting to make waves in cyberspace.

Butterfield came out when she was a 28 year old graduate school student and later as researcher started reading the Bible when working on a project about the religious right. This led her into a friendship with a local pastor and the rest, as they say, is history (Testimony here).

Copies are available at Edinburgh Books, the Free Church Bookshop in Edinburgh, the Covenanter Bookshop in Northern Ireland and ‘Ten of those’.

There are also a number of reviews on the internet (see here, here, here, here and here).

Carl Trueman’s review is one which I would particularly recommend.

There is also a 35-minute audio interview with Rosaria by Tim Challies and David Murray and an hour-long you tube interview with Marvin Olasky of World Magazine.

Trueman gives a number of reasons why every Christian should buy this book and read it:

First, it gives painful insights into how gays and lesbians perceive Christians.

Second, the book brings out beautifully how the gentle vulnerability of a humble pastor and his wife over many months were used by God to bring her into the kingdom.

Third, it shows how conversion often does not immediately solve problems. Butterfield's description of the impact of her conversion is 'comprehensive chaos.' It shattered her career, her network of friends, her reputation with those she loved.

Fourth, it is a paean to the delights of deeply rooted, confessional Reformed Christianity. Butterfield needed a stable, biblically based, historically tested and ecclesiastically responsible theology which only confessional churches provide.

Fifth, her treatment of sexual sin and gender politics is fascinating.

The autobiography is the launch pad for numerous sophisticated reflections on the nature of life, faith, sexuality, worship, education and other matters and, as one would expect from a lover of nineteenth century literature, is also beautifully written.

Trueman concludes, ‘I cannot recommend this book highly enough... It deserves the widest possible readership.’

In listening to Butterfield’s you tube interview I was particularly struck by two things.

First was her account of how John 7:17 had been a key Scripture in helping her come to faith. In it Jesus says, ‘Anyone who chooses to do the will of God will find out whether my teaching comes from God or whether I speak on my own.’

As an English professor with an interest in the order of verbs this fascinated her and became her own experience. ‘I do’ preceded ‘I know’. Obedience was the key to knowing God.

Second I was struck by the personal cost of her decision: ‘A lot of people were hurt by my obedience. In our flesh we want to try to stop the hurt instead of realising that God will use the hurt in the redemption and calling out of people’.

She was helped through this hurt by Christians who had made similar costly sacrifices in other ways to come to a saving knowledge of Christ.

Her challenge? ‘Christian, what did you have to give up to be who you now are?’

I’m looking forward to reading ‘Secret Thoughts’ in full and I hope that the links above will at least serve similarly to whet your own appetite.

Panorama highlights liberal interpretation of abortion law by British doctors

Last Monday I took part in the BBC Panorama programme ‘The Great Abortion Divide’ (watch it on I-Player).

It was presented by Victoria Derbyshire (pictured) and produced by Elizabeth Byrne.

Although extremely controversial it has had very little coverage in the media with only the BBC, Guardian and Times (£) so far reporting on it.

The programme was billed as follows:

‘Abortion is more controversial than ever, with pro-life activists challenging pregnant women as they try to enter clinics. Doctors in most of the UK are signing off terminations on questionable mental health grounds, while in Northern Ireland women and doctors risk life in prison over abortion. So is our legislation hopelessly outdated?’

Victoria Derbyshire, in an article for the Times, (£) asked how it can be so easy to terminate a pregnancy in Croydon, but criminal to do so in Belfast.

This highlights the little known fact that abortion is still effectively illegal in Northern Ireland but there is a situation tantamount to abortion on demand in the rest of the UK where there were over 200,000 abortions last year, 98% on mental health grounds.

I was filmed for an hour last autumn from which they used four sound bites for this programme but I was happy with what they took and felt they put my case well.

The programme was originally due to be screened last December but was held over due to other priorities and I suspect because they also wanted to make reference to the Savita case.

The main point I made in the programme, which I had made previously on the Radio Four Today Programme, is that 98% of abortions in Britain are technically illegal.

This is because they are carried out on grounds that continuing with the pregnancy constitutes a greater risk to a mother’s mental health than having an abortion does.

But in fact a comprehensive study carried out in 2011 by the Royal College of Psychiatrists found that there was no evidence to show that having an abortion posed less risk to mental health than continuing with an unwanted pregnancy.

So when doctors sign an abortion authorisation form (a statutory document) saying that it does I believe they are in effect committing a form of perjury.

Dr Clare Gerada, chairwoman of the Royal College of General Practitioners, said in response to this on the programme however that the current interpretation was realistic as there is no way to predict the impact of continuing a pregnancy on a woman's mental health. She was in effect giving the benefit of any doubt to the mother. Here words were as follows:

‘What we have is what the woman tells us. It is not for me to judge her or be moralistic, it is for me to explore potential other options, but to take her at face value.’

So in other words if the mother thinks that continuing with the pregnancy poses a greater risk to her mental health than having an abortion then she is right, regardless of what the medical evidence actually shows. I wonder if Gerada applies this same diagnostic principle to conditions other than mental health problems.

In saying this I believe Gerada is actually misinterpreting the law. In signing an abortion authorisation she is making a statement that as a doctor she believes in good faith ‘that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the mental health of the pregnant woman’.

She is not actually being asked to make a moral judgement but a medical judgement.

Imagine if we were to substitute another condition for ‘mental health’:

‘I believe that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of (ovarian cancer, schizophrenia, heart disease) to the pregnant woman.’

This would be a medical opinion subject to a test of evidence – as is also danger to mental health.

I see that BPAS (£), Britain’s leading abortion provider, has since leapt to Gerada’s defence. BPAS has since said that doctors are 'not circumventing or breaking the law; they are complying with the law, exercising their clinical judgment and caring for their patients'. Well that is not actually for BPAS to decide.

And if authorising the deaths of 196,000 living human beings is 'caring for their patients' then doctors have moved some distance from the Hippocratic Oath and Declaration of Geneva which actually forbid them performing abortion.

Will the fact that 196,000 abortions are being carried out in the UK every year on these spurious grounds (98% of the total) be at any point the subject of a court case, a police investigation, a GMC inquiry, a parliamentary inquiry, or perhaps even a parliamentary question? We will have to wait and see.

To carry out an abortion on grounds outside those listed in the Abortion Act is still a crime in Britain – and a crime subject to a custodial sentence.

So is perjury – and knowingly making false claims on a statutory document (like an abortion authorisation form) is a form of perjury under the Perjury Act of 1911.

These acts are crimes because abortion is a serious matter, involving as it does the ending of a human life. And as I said on the programme, no one is more innocent, more vulnerable and killed in greater numbers that the preborn baby. Abortion now accounts for 27%, over one in four, of all human deaths in Britain.

One more thing - the programme claimed, without supplying any evidence, that hundreds of women died every year in Britain from illegal abortions prior to the introduction of the Abortion Act. This is patently false as I have argued previously on this blog.

It was good to see the issues around abortion aired again but deep questions still remain, mostly about the abuses by doctors of the current law.

I wonder if anything will be done about this practice which has now been defended on national television by the chair of the Royal College of General Practitioners.

I am not holding my breath.

Tim Loughton MP's letter to constituents about why he opposed the redefinition of marriage

Tim Loughton (pictured) has been the Conservative MP for East Worthing and Shoreham since the 1997 general election. He was the Parliamentary Under-Secretary of State for Children and Families from 2010-2012.

His letter to constituents about why he voted against the redefinition of marriage speaks for itself.

Dear constituent

Thank you for writing to me about the Marriage (Same Sex) Bill which you will have seen was debated in Parliament yesterday. Given your interest from whichever side of the argument I thought you would like to have a link to the Hansard record where you can read a full account of the debate which was very well attended and good natured. Given the number of speakers in a time limited debate contributions were limited to just 4 minutes so my own comments were very limited and I thought I would elaborate a little more on my reasons for opposing the Bill.

I am particularly grateful that the many hundreds of letters, emails and calls I received about the legislation were measured, well intentioned and personally written reflecting constituent’s deeply held views on this contentious issue, rather than the usual lobby group mass circular campaign. Such an approach always has much more influence on me and all MPs. In my comments in the Commons I concentrated on urging all sides to have respect for the views of others however much they may disagree with the opposing view. This is particularly important on a free vote issue not subject to Party policy and obviously not party manifesto commitments at the last election. Each MP needs to vote according to his or her conscience, be transparent in the reasons for that and obviously accountable to constituents.

As they say ‘you can never please all of the people all of the time’ and with over 90,000 constituents to serve voting one way will always disappoint many others urging me to do differently. In the vast majority of cases constituents can respect this impossible position as long as I make myself accountable which I always seek to do. Some I am afraid were quick to despatch emails accusing me of being bigoted, homophobic or closed minded for having voted against ironically revealing their own intolerance on an issue which is all about tolerance and equality of argument. I am afraid abuse from a minority only serves to convince me that I am doing the right thing.

I have set out previously why the measure to redefine marriage to include same sex couples did not sit comfortably with my own long and strongly held beliefs about the nature of marriage. Yesterday I concentrated on almost exclusively secular arguments for why I think this Bill is bad legislation, under 3 main headings: process, the legitimacy of trying to redefine marriage and what next?

As with many other MPs I was very uncomfortable in this Bill coming before Parliament when it did not appear in any Party’s manifesto at the last election; it has not been the subject of any Green paper or White Paper consultation and was not in the Coalition Agreement of May 2010. What is the urgency and legitimacy for rushing the legislation through now when there are many other things which were in our manifesto which are yet to be achieved.

I voted enthusiastically in 2004 for the introduction of Civil Partnerships which gave same sex couples full equivalent rights and entitlements in the eyes of the law and society as for heterosexual couples. I believe that was absolutely the right thing to do and has worked well, it was an end in itself. Yet 9 years on what has happened to make it a priority that we now need the traditional form of marriage to be available to everyone? I do not believe that question has been answered. The Equality lobby groups had not been pressing for it and constituents have not been writing to me about it before it was made a live issue last year. I know many constituents would feel greatly aggrieved if the Government brought forward other completely contentious and new measures of which there was no warning before the last election.

I view Civil Partnerships as no less valued or unequal to marriage. Indeed former Labour Cabinet Minister and equality campaigner Ben Bradshaw said quite clearly that ‘This isn’t a priority for the gay community which already won equal rights. We’ve never needed the word marriage. I agree, which is why it is all the more important that we do not treat such a fundamental issue as the definition of marriage in such a scant and complacent way. For centuries marriage has been recognised as the cornerstone of family life as the union of one man with one woman, subject to being above the age of consent, willing, available and not closely related. That is a benchmark which has been clearly understood across a whole range of faiths and cultures and across political boundaries, even before states and religions existed.

Whether you have faith yourself or not we all have a duty to respect and tolerate the beliefs of those who do, and for many of faith redefining marriage in this way is a significant hurdle for them to cross. So my challenge which again has not been answered is on what basis does this Government or this country believe it can change the nature of an institution which has been constant for ages across all boundaries, state and cultural?

Thirdly there are very serious concerns under the ‘What Next’ category. In the future will marriage be redefined further, and to what, and indeed what will the whole point of marriage become when as this bill does we render gender meaningless for the purposes of a marriage? This contrasts with it currently being the central social institution which expresses the idea that men and women are equally valuable as men and women.

As I have said, I do not regard my church marriage as superior to another man’s civil partnership, it is just different. In any case we do not think of people as religiously married or civilly married, they are just married. But the debate about same sex marriage is a debate about using the law to change the meaning of the social institution of marriage, and that affects everyone. When you politicise a fundamentally social institution as is now being proposed you change marriage for all. It is not about just giving a one way entitlement to same sex couples.

For people who cannot accept such a change because it conflicts with their faith or conscience then will they be penalised under the law just as we have seen cases in the European Court where registrars, relationship counsellors and housing officers have lost their jobs because they could not endorse civil partnerships. Already a poll has indicated that up to 40,000 teachers would decline teaching about same sex marriage. NHS and army chaplains and many other public service workers might also see their positions compromised let alone ministers in other religions who we are promised will not be forced to be involved in same sex marriages.

Importantly the senior law officers in Parliament have so far been unable to give definitive answers about some of the likely knock on effects and just how securely the Government’s proposed ‘quadruple lock mechanism’ will stand up in the courts. It was telling in the main vote after the debate on the Bill that the Attorney General deliberately abstained and the Solicitor General voted against the legislation.

There are many other potential flaws in the legislation and its workability which will now come under closer scrutiny as the Bill proceeds into Committee stages where I am likely to be a member, before it passes on to the lords where there is likely to be much fierce debate.

My bottom line is that I do not recognise that this Bill is an equality measure. It imparts no additional rights or entitlements on same sex couples than had not already quite rightly been achieved through civil partnerships. If it were otherwise I would be at the front of the queue to right such an injustice.

Where I do think the problem lies is that in some parts of our society gay people are still not properly accepted, respected and in some cases discriminated against. That is not acceptable and that is the challenge that we have to address once and for all if we are to achieve a society fit for the 21st century in which all can live comfortably, securely and equally. That is a challenge and duty for all of us and the Government needs to continue to take the lead on this. However, promoting legislation which is about changing a word and the nature of a ceremony will not achieve this in my view and that is why I opposed this legislation.

I hope this is helpful and as usual I welcome your further interest.

Yours sincerely

Tim Loughton MP

Coalition for marriage delighted with opposition to gay marriage bill

Here is the press release from the Coalition for Marriage (C4M) which went out last night after the House of Commons voted in favour of legalising same sex marriage.

C4M delighted by the scale of the Parliamentary opposition to ill-thought through and divisive gay marriage bill

Responding to the news that 175 MPs voted against and a further 70 abstained, or were absent at Second Reading, Colin Hart, Campaign Director for Coalition for Marriage commented: “The scale of the opposition against the Government’s profoundly undemocratic plans is astonishing, and sends a clear message to the Prime Minister that he faces a lengthy and damaging battle to redefine marriage.

“Just a few months ago, if we had predicted this result, no one would have believed us, but our clear and simple message that these proposals are undemocratic and will lead to all sorts of unintended consequences has struck a chord with ordinary voters and now scores of MPs.

“We have consistently warned the legislation contains no safeguards for those who work in the public sector. Top lawyers, with a track record of winning against the Government, have said the quadruple lock is not sustainable and instead of trying to answer these questions the PM remains hell bent on ramming this bill through Parliament in a dangerously short period of time.

“Mr Cameron hopes that this matter is now settled. He is wrong. His attempts to distract those in his own party and the wider country from the fall out will fail. More importantly this is not the end of the fight against these ill-thought through and divisive plans. There are more votes in the Commons, more speeches, potentially dozens of amendments and then the bill will go to the Lords where the voting arithmetic is very different.”

The Coalition for Marriage has brought together groups and individuals who oppose the redefinition of marriage. So far over 636,000 have signed their petition which reads, 'I support the legal definition of marriage which is the voluntary union for life of one man and one woman to the exclusion of all others. I oppose any attempt to redefine it.'

I don't mind being insulted but I don't like being misrepresented

Last Monday night I took part in a BBC Panorama programme on abortion (report here) and received the usual barrage of abusive tweets on twitter. I am well used to that.

But Dr David Jones (@welsh_gas_doc) (pictured) - a Welsh doctor with almost 10,000 followers on twitter - also tried to undermine me by making the claim that I had no mandate from my organisation to speak on the programme.

This message was then retweeted 52 times around the internet to tens of thousands of people.

As CEO of CMF I took part in the Panorama programme speaking on its behalf and I believe the claim that Dr David Jones made was actually libellous.

In fact on the basis of recent precedent those who retweeted this false information aimed at damaging my reputation may be equally culpable.

When I challenged Dr Jones about it he eventually withdrew the statement 78 minutes later. The conversation thread is below.

Perhaps predictably no one has retweeted Dr Jones apology.

I don't mind being insulted - in fact I expect it (see here) - but I don't like being misrepresented.

I note that Dr Jones has previously featured in both the Daily Mail and Daily Telegraph for his 'flippant' and 'offensive' tweeting.

NB: According to a recent BBC guide a tweet is potentially libellous in England and Wales if it damages someone's reputation 'in the estimation of right thinking members of society'. It can do this by exposing them to 'hatred, ridicule or contempt'. It is a civil offence so you won't be jailed but you could end up with a large damages bill. The rules also apply to re-tweets.

Doctors cannot encourage or assist suicide: Official

Almost a year after its consultation closed, the UK General Medical Council issued on 31 January its guidance about what doctors can and cannot do with patients who consult them about assistance with suicide.

Contrary to the spin suggested by Dignity in Dying (the former Voluntary Euthanasia Society) and its satellite, Healthcare Professionals for Assisted Dying, the only clarification which could remotely be seen as a concession is that doctors who respond to a valid request and solely hand over the medical records required by Dignitas for confirmation of diagnosis are unlikely to face sanction by the GMC.

Otherwise, the 6-page guidance for the GMC’s pre-hearing investigators ‘considering allegations about a doctor’s involvement in encouraging or assisting suicide’ upholds the law as it stands and sends no signals at all to suggest the profession endorses assistance with suicide. Although of course the GMC recognises its neutral role and states ‘Nothing… should…be taken to imply that the GMC supports or opposes a change in…law’, the guidance helpfully underlines the law and the profession’s position.

Action concerning a doctor’s fitness to practise is certain when:

•a doctor has been convicted of encouraging or assisting suicide

and probable when

•a doctor has accepted a caution and/or has been the subject of an adverse determination by another regulatory body for encouraging or assisting suicide
•the doctor’s encouragement or assistance depended upon the use of privileges conferred by a licence to practise medicine (such as prescribing) or took place in the context of a doctor-patient relationship
•the doctor knew, or should reasonably have known, that their actions would encourage or assist suicide
•the doctor acted with intent to encourage or assist suicide

Also likely to lead to action are:

•encouraging a person to commit suicide, for example by suggesting it (whether prompted or unprompted) as a ‘treatment’ option in dealing with the person’s disease or condition
•providing practical assistance, for example by helping a person who wishes to commit suicide to travel to the place where they will be assisted to do so
•writing reports knowing, or having reasonable suspicion, that the reports will be used to enable the person to obtain encouragement or assistance in committing suicide
•providing information or advice about other sources of information about assisted suicide
•providing information or advice about methods of committing suicide, and what each method involves from a medical perspective

Guidance follows about ‘realistic prospects’ for proof, and the only ‘Allegations that will not normally give rise to a question of impaired fitness to practise’ because of their lawfulness or their distance from the encouragement or assistance include:

•providing advice or information limited to the doctor’s understanding of the law relating to encouraging or assisting suicide
•providing access to a patient’s records where a subject access request has been made in accordance with the terms of the Data Protection Act 1998
•providing information or evidence in the context of legal proceedings relating to encouraging or assisting suicide

Wisely, the GMC has also released shorter 2-page guidance aimed at patients and those close to them, which summarises the principles and the legal limits detailed for doctors.

Clarifying that ‘respect for a patient’s autonomy cannot justify illegal action’, doctors should ‘limit any advice or information about suicide to an explanation that it is a criminal offence to encourage or assist a person to commit or attempt suicide’.

The position of doctors is now clear to all and does not need changing.

The BMA has welcomed the guidance and the Medical Defence Union (MDU) has not revised its previous warning that doctors who provide medical reports for patients seeking assisted suicide abroad could be prosecuted.

Francis Inquiry – Key conclusions and links

Robert Francis QC has today published his findings after a 31-month public inquiry costing £13 million into why up to 1,200 patients died needlessly in Stafford between 2005 and 2009.

Links

Final report
Executive summary
BBC Live report
BBC Report
BMA responses

Francis said it would be ‘dangerous’ to blame ‘a single rogue healthcare professional’ for what went wrong. His 1,782-page report contains 290 recommendations.

The Telegraph reports as follows:

(Francis) said of the scandal: ‘This is a story of appalling and unnecessary suffering of hundreds of people. They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety. Patients were let down by the Mid Staffordshire NHS Foundation Trust. There was a lack of care, compassion, humanity and leadership. The most basic standards of care were not observed, and fundamental rights to dignity were not respected.’

The evidence of more than 250 witnesses and more than a million pages of documentary evidence showed that elderly and vulnerable patients were left unwashed, unfed and without fluids, said Mr Francis. Some patients had to relieve themselves in their beds when they got no help to go to the bathroom, others were left in excrement-stained sheets and had to endure ‘filthy conditions’ onwards.

In a letter to the Health Secretary, Jeremy Hunt, accompanying the report, Mr Francis said hospitals must put patients first, ensure ‘openness, transparency and candour’ throughout the NHS when concerns are raised and ensure proper accountability for what staff do.

He said the scandal happened because board members and other leaders within the Trust ‘failed to appreciate the enormity of what was happening, and reacted too slowly, if at all’.
He says ‘routine neglect’ became the norm because of a culture of ‘fear, bullying and secrecy’.

The Trust had a culture of ‘self promotion rather than critical analysis’ and consultants ‘did not pursue management with any vigour’ about concerns they had and in many cases ‘kept their heads down’’

The Trust focused on finances rather than patient needs, he said, and ‘squabbling’ between local patient groups such as community health councils meant that “the public of Stafford were left with no effective voice...throughout the worst crisis any district general hospital in the NHS can ever have known’.

Francis’ full letter to the secretary of state is reproduced below:

Dear Secretary of State

Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry

As you know, I was appointed by your predecessor to chair a public inquiry under the Inquiries Act 2005 into the serious failings at the Mid Staffordshire NHS Foundation Trust. Under the Terms of Reference of the Inquiry, I now submit to you the final report.

Building on the report of the first inquiry, the story it tells is first and foremost of appalling suffering of many patients. This was primarily caused by a serious failure on the part of a provider Trust Board.

It did not listen sufficiently to its patients and staff or ensure the correction of deficiencies brought to the Trust’s attention. Above all, it failed to tackle an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities. This failure was in part the consequence of allowing a focus on reaching national access targets, achieving financial balance and seeking foundation trust status to be at the cost of delivering acceptable standards of care.

The story would be bad enough if it ended there, but it did not. The NHS system includes many checks and balances which should have prevented serious systemic failure of this sort. There were and are a plethora of agencies, scrutiny groups, commissioners, regulators and professional bodies, all of whom might have been expected by patients and the public to detect and do something effective to remedy non-compliance with acceptable standards of care. For years that did not occur, and even after the start of the Healthcare Commission investigation, conducted because of the realisation that there was serious cause for concern, patients were, in my view, left at risk with inadequate intervention until after the completion of that investigation a year later. In short, a system which ought to have picked up and dealt with a deficiency of this scale failed in its primary duty to protect patients and maintain confidence in the healthcare system.

The report has identified numerous warning signs which cumulatively, or in some cases singly, could and should have alerted the system to the problems developing at the Trust. That they did not has a number of causes, among them:

•A culture focused on doing the system’s business – not that of the patients;
•An institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern;
•Standards and methods of measuring compliance which did not focus on the effect of service on patients;
•Too great a degree of tolerance of poor standards and of risk to patients;
•A failure of communication between the many agencies to share their knowledge of concerns;
•Assumptions that monitoring, performance management or intervention was the responsibility of someone else;
•A failure to tackle challenges to the building up of a positive culture, in nursing in particular but also within the medical profession;
•A failure to appreciate until recently the risk of disruptive loss of corporate memory and focus resulting from repeated, multi-level reorganisation.

I have made a great many recommendations, no single one of which is on its own the solution to the many concerns identified. The essential aims of what I have suggested are to:

•Foster a common culture shared by all in the service of putting the patient first;
•Develop a set of fundamental standards, easily understood and accepted by patients, the public and healthcare staff, the breach of which should not be tolerated;
•Provide professionally endorsed and evidence-based means of compliance with these fundamental standards which can be understood and adopted by the staff who have to provide the service;
•Ensure openness, transparency and candour throughout the system about matters of concern;
•Ensure that the relentless focus of the healthcare regulator is on policing compliance with these standards;
•Make all those who provide care for patients – individuals and organisations – properly accountable for what they do and to ensure that the public is protected from those not fit to provide such a service;
•Provide for a proper degree of accountability for senior managers and leaders to place all with responsibility for protecting the interests of patients on a level playing field;
•Enhance the recruitment, education, training and support of all the key contributors to the provision of healthcare, but in particular those in nursing and leadership positions, to integrate the essential shared values of the common culture into everything they do;
•Develop and share ever improving means of measuring and understanding the performance of individual professionals, teams, units and provider organisations for the patients, the public, and all other stakeholders in the system.

In introducing the first report, I said that it should be patients – not numbers – which counted. That remains my view. The demands for financial control, corporate governance, commissioning and regulatory systems are understandable and in many cases necessary. But it is not the system itself which will ensure that the patient is put first day in and day out. Any system should be capable of caring and delivering an acceptable level of care to each patient treated, but this report shows that this cannot be assumed to be happening.

The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed. This does not require a root and branch reorganisation – the system has had many of those – but it requires changes which can largely be implemented within the system that has now been created by the new reforms. I hope that the recommendations in this report can contribute to that end and put patients where they are entitled to be – the first and foremost consideration of the system and everyone who works in it.

Yours sincerely

Robert Francis QC
Inquiry Chairman