Writing in the week the Francis report on Mid-Staffordshire was published I wondered whether I was alone in seeing a glaring hole in the report's conclusions and recommendations? Or alone at being both angry and saddened as a result?

One of the most striking aspects of the whole mess has surely been the failure of local systems to recognise the concerns of local people until too late, married with the driven campaigning by local self-organising people, which has persevered throughout, and may yet succeed in getting a formal public enquiry (although I doubt it).  Involvement in decision-making, and especially the consequences of not involving, have been centre-stage.  But would you know it from reading the report?

Only Recommendation 17 (of the 18 made) refers directly to the need to change the relationship with local people ("should consider steps to enhance the rebuilding of public confidence", is hardly a ringing call to action).  The report suggests strengthening the role of Governors (of the Foundation Trust (FT)), and criticises the complacency and approach of the Board.  Although the second recommendation is that the Government should review the hospital's FT status it sits on the fence about whether it should in fact be revoked - so there appears to be confusion, still, about how to deal with the failed governance and regulatory processes (hence the further report on regulatory and commissioning matters).

So, while the report explicitly and implicitly makes restoring the trust of local people a key issue, it is extraordinarily weak on what measures could be taken to do so that actually involve those same people.  What has now been given to local managers is a set of clinical and operational management tasks, functioning entirely within the prevailing bureaucratic mindset.  This is not a report which shifts the paradigm of 'professionals know best'.  On the contrary it seems to re-enforce it, as it repeatedly stresses the failure to meet entirely appropriate minimum standards, especially clinical ones.  And it seems likely to lead to further professionalisation of the management of services (we have no problem with the principle of that).  However, it does so without equal weight on the engagement of local people in decision-making, for individual care or for 'big' decisions, or placing equal value in their contribution. 

No doubt Mid Staffs represents failure of professionalism and of regulation - however, the answer doesn't simply lie in more professionalism or more regulation, it lies also in greater openness and more involvement of those who are affected by such decisions. 

This is not in place of professionalism, but is essential if we are to achieve new levels of assurance about the quality of services and new relationships between people and their public services.

So, the lessons of Mid-Staffordshire are many, and they apply to many areas of public service.  But the big lessons have surely been lost in the rush to add yet more 'professionalism' to the delivery of service.  Doesnt that make YOU angry and sad?