Mid Staffordshire NHS Foundation Trust

The Francis Report

‘The Inquiry examined the roles of the commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire hospital between January 2005 and March 2009’ Mid Staffordshire NHS Foundation Trust Public Inquiry Press Release, 6 February 2013

The Organisations Under the Spotlight

A Negative Culture?

HABITUATION

Tolerance Denial External reassurance Someone else’s problem

PRESSURE

Targets Finance FT status Jobs

BEHAVIOUR

Uncaring Unwelcoming Bullying Keeping head down

REACTION

Fear Low morale Isolation Disengagement No openness

The Inquiry

• The Francis Inquiry conducted 300 interviews • It looked at 1000+ documents • The final report spanned 3 Volumes of over 1800 pages • The inquiry made 290 Recommendations and cost £13.5m

Robert Francis’ Recommendations

• fundamental standards • measures of compliance • duty of candour underpinned by statute • improved support for nursing • stronger healthcare leadership • registration scheme of fit and proper persons

The Findings

• Preventing problems • Detecting problems quickly • Taking action promptly • Ensuring robust accountability • Ensuring staff are trained and motivated

‘Any system should be capable of caring and delivering an acceptable level of care to each patient treated, but this report shows that this cannot be assumed to be happening.’ ‘In short, a system which ought to have picked up and dealt with a deficiency of this scale failed in its primary duty to protect patients and maintain confidence in the healthcare system.’

Robert Francis QC Final Report Of The Independent Inquiry Into Care Provided By Mid Staffordshire NHS Foundation Trust

The Care Quality Commission

• The Francis Inquiry was one of a number of triggers that prompted changes in the regulatory model – Close scrutiny of the regulation of health and social care – Public Accounts Committee – Winterbourne view – Morecambe Bay – Greater need to include the views of patients and carers in the assessment of the quality of services

Care Quality Commission

• A number of changes to the regulatory approach were prompted by Francis: – Closer partnership working e.g. the Trust Development Agency, GMC and Monitor – Differentiated regulation – More emphasis on a specialist inspection model – Intensive inspection of hospitals – Better use of key information sources such as complaints and coroners reports – Better use of the press and media – A return to rating services

Questions for Consideration by the RQIA Board

1) In light of the Francis and Keogh reports, what should RQIA do to strengthen regulation of acute hospitals across Northern Ireland?

2) Should RQIA rate HSC hospitals for quality? What would this entail?

3) How can RQIA use intelligence from other sources to inform risk?