So the day of reckoning is nearly upon us. The Francis inquiry report into the scandal at Mid-Staffordshire Foundation Trust will be handed to the health secretary on 5 February and published the following day.

It has certainly been a long time coming. It was finished in 2010 and was meant to be published in October but was further delayed after Robert Francis decided there was a need to give those criticised in the report a right of reply.

16 staffordshire w Mid Staffordshire scandal: day of reckoning beckons

In the meantime, the Department of Health has begun pre-empting the report. Sir David Nicholson, the NHS commissioning board chief executive – otherwise known as the most powerful man in the health service – has let it be known that he hopes to survive the report.

Sir David, of course, was chief executive of Shropshire and Staffordshire strategic health authority between 2005 and 2006. (For those coming new to the subject, the inquiry looked at the appalling lack of care at the trust between 2005 and 2009.)

Jeremy Hunt has himself given a number of interviews where he has also called for total openness and transparency when things go wrong and he has said that NHS managers cannot expect to keep their jobs if they preside over failings in care.

Bosses held to account?

So does that mean come publication day that one of the many people in charge at the time will finally be held to account? Because so far nobody has and, indeed, several have gone on to greater things in the NHS. Even the chief executive of the trust, Martin Yeates, left with a pay off and took over as chief executive of a drugs and alcohol charity. He only suddenly stood down a couple of weeks ago when the Mid-Staffs pressure began to grow.

Then there is the question over just how transparent and accountable the system will become? There is a great deal of pressure from organisations like AvMA, the medical negligence charity, for duty of candour to be made a legal requirement. That is, if someone sees something appalling happening at a hospital they would be law, have to say something.

That is being hugely resisted by the government. Last December they announced that it will be a standard clause in NHS contracts, a move AvMA chief executive Peter Walsh described at the time as an “apparently cynical attempt to sidestep overwhelming support for a statutory duty and to pre-empt the public inquiry report”.

So what will they do if the Francis inquiry report also says (and many believe this will happen) that it should be a legal requirement? Will the government do a U-turn? Or will they ignore that bit of what is likely to be a very long read?

And will the complaints system itself be improved? Because it needs to be. I have spoken to so many patients around England who have made perfectly valid complaints and have been fobbed off with obfuscating responses that all seem terribly formulaic.

And this always means that the complaint goes further because the bereaved and aggrieved do not feel they are being dealt with properly and with decency.

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