This response to the report by lawyer Robert Francis into the failure of National Health Service (NHS) care in Mid-Staffordshire is fairly positive about its conclusions but points out that without consideration of personal, psychosocial factors in care, on the ward, in the institution things are unlikely to improve, the report leaves much unconsidered. Francis emphasises that patient care is at the very centre of the NHS, this is obvious but so often forgotten. He comments that the unhelpful blame culture still exists. Missing from Francis’ analysis is a psychological perspective – the systemic factors he mentions are administrative not relational. This response is an attempt to redress the balance in thinking about the improvement of care for patients and of the working lives of staff.