Sarah Bellars Director of Nursing and Clinical Quality Windsor Ascot and Maidenhead Clinical Commissioning Group Francis Inquiry Sarah Bellars Director of Nursing and Clinical Quality

Introduction 2005-2008- Poor care flourished Foundation Trust Status Meeting standards High mortality rates Patient voice Health Care Commission investigation 2008 2010 Francis report- 18 recommendation's June 2010- Public Inquiry Francis 2 commissioned Feb 2013- Francis 2 report published 290 recommendations. Between 2005 and 2008 conditions of appalling care were able to flourish in the main hospital serving the people of Stafford and its surrounding area, Mid‐Staffordshire NHS Foundation Trust. During this period of time the Trust had come under close scrutiny in relation to its application for Foundation Trust status by the Department of Health, the Strategic Health Authority, Monitor, the Healthcare Commission, and the NHS Litigation Authority alongside local scrutiny groups and public involvement groups all of which had found that the Trust met the applicable standards and found no systematic failings. The truth was uncovered in part by attention being paid to the true implications of its mortality rates, but mainly because of the persistent complaints made by a very determined group of patients and those close to them.

“I heard so many stories of shocking care “I heard so many stories of shocking care. These patients were not simply numbers they were husbands, wives, sons, daughters, fathers, mothers, grandparents. They were people who entered Stafford Hospital and rightly expected to be well cared for and treated. Instead, many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives.“ Robert Francis 996 members of the public- 72% expressed concerns Estimates range between 400 and 1200 unnecessary deaths Unable to single out a patient story. Common themes included Unanswered call bells Failure to detect deterioration/complete basic observations Lack of empathy and compassion- basic human kindness Failure to ensure adequate hydration and nutrition, I am sure we have all heard about the patients that were so thirsty they had to drink flower water…I could go on…

Recommendation's The report sets out a total of 290 recommendations. Francis identified five themes. Unlike the previous NHS inquiry, this long-awaited report was the result of a public inquiry which not only investigated Mid Staffordshire NHS Foundation Trust but looked more broadly at the failure regime in general.

1. A structure of fundamental standards and measures of compliance. Fundamental standards patients can expect to receive and defined by the partnership between patient and provider. Non compliance should not be tolerated and these services will be suspended To cause death or serious harm to a patient by non compliance without reasonable excuse of the fundamental standards, should be a criminal offence These fundamental standards should be policed by the Care Quality Commission (CQC) Recommendations 1 A list of clear fundamental standards, which any patient is entitled to expect which identify the basic standards of care which should be in place to permit any hospital service to continue. These standards should be defined in genuine partnership with patients, the public and healthcare professionals and enshrined as duties, which healthcare providers must comply with. Non compliance should not be tolerated and any organisation not able to consistently comply should be prevented from continuing a service which exposes a patient to risk To cause death or serious harm to a patient by non compliance without reasonable excuse of the fundamental standards, should be a criminal offence. Standard procedures and guidance to enable organisation and individuals to comply with these fundamental standards should be produced by the National Institute for Clinical Excellence with the help of professional and patient organisations. These fundamental standards should be policed by the Care Quality Commission (CQC)

2. Openness, transparency and candour throughout the system underpinned by statute. Statutory duty to be truthful to patients where harm has or may have been caused Staff to be obliged by statute to make their employers aware of incidents in which harm has been or may have been caused to a patient Trusts have to be open and honest with balanced quality accounts criminal offence if deliberate deception The CQC should be responsible for policing these obligations Recommendations 2 A statutory duty to be truthful to patients where harm has or may have been caused Staff to be obliged by statute to make their employers aware of incidents in which harm has been or may have been caused to a patient Trusts have to be open and honest in their quality accounts describing their faults as well as their successes The deliberate obstruction of the performance of these duties and the deliberate deception of patients and the public should be a criminal offence It should be a criminal offence for the directors of Trusts to give deliberately misleading information to the public and the regulators The CQC should be responsible for policing these obligations

3. Improved support for caring, compassionate, and considerate nursing. Practically based nurse training. value based recruitment. Nursing leadership at ward level should be enhanced. There should be enhanced annual appraisal for all nurses and consideration for revalidation. A new specialism in older person’s nursing should be considered. There should be common standards of training and registration for healthcare support workers. Recommendations 3 There should be changes to nurse training to make it more practically based. Recruitment to the profession should change to ensure those entering training have the right values. Nursing leadership at ward level should be enhanced. There should be enhanced annual appraisal for all nurses. There should be responsible officers for nursing and a process of revalidation for nurses should be considered. A new specialism in older person’s nursing should be considered. There should be common standards of training and registration for healthcare support workers.

4. Stronger healthcare leadership The establishment of an NHS leadership college Ability to disqualify those guilty of serious breaches of the code of conduct. A registration scheme for Directors Recommendations 4 The establishment of an NHS leadership college, offering all potential and current leaders the chance to share in a common form of training to exemplify and implement a common culture, code of ethics and conduct It should be possible to disqualify those guilty of serious breaches of the code of conduct or otherwise found unfit from Eligibility for leadership posts A registration scheme and a requirement need to be established that only fit and proper persons are eligible to be directors of NHS organisations.

5. Accurate, useful and relevant information. Clear widely used metrics on clinical quality. Independent publicly available information from the NHS Information Centre. Each clinical service must publish real-time data on patient safety and compliance with minimum quality standards. Each provider should have a board member with a responsibility for information. There should be clear widely used metrics on clinical quality. The NHS Information Centre should independently collect, analyse and publish healthcare information. Each clinical service must publish real-time data on patient safety and compliance with minimum quality standards. Each provider should have a board member with a responsibility for information.

CCG The CCG wants to ensure that it fully considers the implications from this report and the government response, as well as the recommendations for boards outlined in the report from the National Quality Board (NQB). Providers have been formally requested to review the recommendations of this report and develop and share with the CCG plans to address gaps identified. It is recommended to this Governing Body that a CCG implementation plan is developed with the inclusion of HealthWatch to return to the July Governing Body meeting.

CCG response continued All Governing Body members have a responsibility to familiarise themselves with this report and all the recommendations. The full report and executive summary can be found at: http://www.midstaffspublicinquiry.com/report

"People must always come before numbers "People must always come before numbers. Individual patients and their treatment are what really matters. Statistics, benchmarks and action plans are tools not ends in themselves. They should not come before patients and their experiences. This is what must be remembered by all those who design and implement policy for the NHS." Robert Francis