A "profound tension" is facing the NHS over the amount of money available and the need to provide high quality care, according to a report published on the one year anniversary of the inquiry into Mid Staffs.
High quality care must be centre stage in the NHS and take priority over hitting targets, a report put together by key managers in health service trusts said.
The research found enthusiasm for the proposals put forward by the Francis report, but warned of a "profound tension" between the quality of car desired and what could be paid for.
However, the report noted that one leader said: "I'd rather be hung for money than for quality and safety."
The report said Francis had "brought a powerful sense of professional shame" but added:
The pressure to stay within limited budgets that existed at the time of Mid Staffordshire has not gone away but has intensified, as funding increases for the NHS have been frozen in real terms since 2011/12.
Writing in a report on the future of the NHS, Robert Francis QC said it was "unacceptable to pretend that all can be provided to an acceptable standard when that is not true".
Mr Francis, who wrote the foreword, said NHS trusts who were unable to supply quality services within budget should trust leaders "to communicate that openly to those responsible for commissioning and funding services."
However, Mr Francis did report that the focus of trusts had shifted away from box ticking towards the belief that "quality needs to be given much greater priority".
Mr Francis' inquiry report was published exactly a year ago and contained 290 recommendations for action to prevent another scandal like at Stafford Hospital.
Between 400 and 1,200 more patients died than would normally be expected at Mid Staffordshire NHS Foundation Trust during years of neglect.