The Government response to the Francis Inquiry – outline slide set November 2013

Timeline : 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 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 reportfinal report 26 March 2013: Government publishes its initial response Patients First and Foremost and commissions further reviews of patient safety, bureaucracy, complaints andPatients First and Foremost 19 November 2013: Government publishes its full response to the Francis Inquiry, Hard Truths – the journey to putting patients firstHard 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 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 King’s Fund and University of Lancaster to examine evidence- based 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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