Transcript Francis slide pack

The Government response to
the Francis Inquiry – outline
slide set
November 2013
Timeline
•2005-2008: reports of failings at Mid Staffordshire
NHS Foundation Trust emerge
•March 2009: Healthcare Commission publishes
report of its investigation
•24 February 2010: Robert Francis QC publishes
report of independent inquiry
• 9 June 2010: Andrew Lansley announces a full
public inquiry into the failings at Mid-Staffordshire
NHS Foundation Trust
Timeline
•8 November 2010: Public inquiry opens
•6 February 2013: Robert Francis QC publishes the
inquiry’s final report
•26 March 2013: Government publishes its initial
response Patients First and Foremost and
commissions further reviews of patient safety,
bureaucracy, complaints and
•19 November 2013: Government publishes its full
response to the Francis Inquiry, Hard Truths – the
journey to putting patients first
Key messages from the Francis Inquiry
•This was a system failure as well as failure of an
individual organisation
•No single recommendation should be regarded as
the solution to the many concerns identified
•A fundamental change in culture is required
across the NHS
•We need to secure the engagement of every single
person serving patients in the change that needs to
happen
The media focus
• “Patients will be told how many nurses should be
on each ward”
• “...bosses will be barred from the NHS”
• “Hospitals could have to pay for mistakes”
• “Hospitals must be open about failings, says Hunt”
• “NHS must reveal ‘near misses’”
• “Patients to get named doctors after Mid Staffs”
• Limited press coverage of important areas like
staff engagement, leadership, culture
Hard Truths- Chapter One: Preventing
problems
•Patient safety: Patient Safety Collaborative Network to spread best practice.
Greater involvement of patients in decisions and patient safety data to be more
accessible to the public. National Quality Board to work with NHS organisations and
staff to maximise the potential of Human Factors practice and principles. New
offence of wilful neglect.
•Rights and responsibilities: NHS England, CCGs and HEE working with NHS
staff and patients on embedding the NHS Constitution
•Staff wellbeing as the foundation of compassionate care: Point of Care
Foundation to work on spreading Schwartz Rounds.
•Complaints: Chief executives and Boards to take greater personal responsibility
for complaints
•Openness and transparency: Statutory duty of candour on organisations;
professional duty of candour on individuals
•Staffing and recruitment: Values based recruitment. Guidance and toolkits on
safe staffing levels, with CQC to inspect
Hard Truths - Chapter Two: Detecting
problems quickly
•Standards: clear fundamental standards to be developed by DH and CQC,
complemented by discretionary enhanced quality standards and longer term
developmental standards developed by NICE.
•Inspection: expert-led inspection, all acute trusts will have been inspected under
the new system by the end of 2015. Inspection to consider the culture of the
organisation and where it promotes openness and transparency.
•Quality: Monitor will be publishing an updated Code of Governance for Foundation
Trusts in early 2014. King’s Fund and University of Lancaster to examine evidencebased solutions for evaluating leadership and culture within an organisation. Quality
surveillance groups to ensure that the different organisations with an interest in
quality are aligned at local and regional levels
•Registration and licensing: joint registration and licensing system to be
implemented by Monitor and CQC from April, with clearer delineation of their
respective roles and FT process
Hard Truths - Chapter Three: Taking
action promptly
•Collaboration: CQC, Monitor and TDA will publish further guidance on how they
work together to address quality after April 2014
•Ratings: Ratings will be published for certain individual services, eg emergency or
maternity, as well as for the hospital overall
•Intervention: CQC to have powers to act immediately if patients at immediate risk
of harm. DH intends to enable Monitor to impose additional licence conditions on
trusts issues with a CQC warning notice. Where FTs are placed in special
measures, they will have their autonomy suspended.
•Special administration: Special administration as a last resort, with the majority of
failures resolved through actions taken by trust boards and a minority through
service redesign driven by local commissioners
Hard Truths - Chapter Four: Ensuring
robust accountability
•At board level: A fit and proper persons test, regulated by CQC, will be
introduced for board directors or equivalents across public, private and voluntary
sector providers. Greater performance management at board level., with contracts
to be reworded to make it easier for leaders to be removed when CQC ratings are
unsatisfactory. Guidance on healthy NHS boards.
•Professional regulation: Law Commission working on streamlining professional
regulation law, enabling the majority of concerns to be resolved within a year
•Commissioners: NHS England to examine standard NHS contract provisions to
facilitate commissioner intervention in case of concerns
•Coroners: regulations to be published strengthening requirement of
independence.
Hard Truths - Chapter Five: Ensuring
staff are trained and motivated
•Staff engagement: Chief Inspector of Hospitals to cover staff engagement. Social
Partnership Forum to develop a description of what good staff engagement looks
like for employers.
•Older people: Older Persons Nurse Fellowship programme. Taskforce led by Age
UK to reduce malnutrition among older people in a range of health and care settings
•Nursing and care assistants: Leadership Academy to support nurse leadership,
while NMC will begin revalidation for nurses. Development of Care Certificate for
healthcare assistants and social care support workers. Better dismissal procedures
for healthcare assistants and improved recognition of good practice.
•Bureaucracy: HSCIC to act as ‘gateway’ for information requests and national
bodies to have single transparent process, reducing the burden of bureaucracy.
NHS England Clinical Bureaucracy Index to track how well trusts are using digital
technology in data collection.
•Leadership: NHS Leadership Academy to initiate a new leadership programme to
fast-track NHS clinicians and individuals from outside the NHS to be the next
generation of senior leaders; while NHS Executive fast-track programme to develop
leaders from inside the NHS.
Key quotes from the Government
response
“If staff are to deliver good, compassionate care, it is critical
to care for them so that they can care properly for
others. Good working environments have the right levels of
staff with the right skills, and support from colleagues and
managers."
“Systematically creating an environment in which
compassionate care is the norm requires imaginative
commissioning, organisational commitment, planning,
education, training, reinforcement through leadership and
insightful scrutiny and challenge. It is the very opposite of the
‘soft’ issue it can too often be characterised as. Ensuring
compassionate care is therefore not an ‘issue’ for
organisations providing care. It is, along with safety, the
essence of the business that they are in."
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