1. Response to the Francis Report This document details the processes undertaken so far in response to publication of the Francis Report in February 2013.

2. What its about.. The Francis Inquiry was published on 6 th February 2013.This Inquiry process has been examining the commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire hospital between January 2005 and March 2009. The Inquiry has considered why the serious problems at the Trust were not identified and acted on sooner, and identifying important lessons to be learnt for the future of patient care. The fully report builds on Mr Francis’s earlier report, published in 2010 after the independent inquiry on the failings in the Mid Staffordshire NHS Foundation Trust between 2005 and 2009. The Inquiry identifies a story of terrible and unnecessary suffering of hundreds of patients and has far reaching consequences for the NHS as a whole.

3. The Francis Report (2013) 1 million pages of documentary material More than 250 witnesses 139 days of oral hearings Terms of reference announced 9 June 2010 Report handed to Sec of State 5 February 2013 Costs £13 million to November 2013 1781 pages 290 recommendations

4. The CCG Response Listening A briefing paper following publication of the report was discussed by the Board on 12th February 2013. Brief shared with the Health Roundtable Members. CCG Board Development day was held on 30th April 2013 to discuss the report the recommendations and response. An individual letter was sent to all CCG employees from the Chief Officer inviting attendance at the CCG Listening Event held on 2nd May 2013. The Quality Team away day considered their role in relation to the report on 20th May 2013. Formal response agreed by Governance Board 11 th June 2013

5. How can we engage patients, who are representative of our population, in services and providing real time feedback? Embrace social media  Actively seek out non-participants  Culture change – reassure staff of benefits  Encourage exchange of ideas  No box ticking  Build PPG’s  Patient representation across the health economy  Patient rep forum  Newsletter How easy is it for patients, relatives and the public to speak up and talk to us? What can we do to promote a culture of openness? It is not difficult to complain if you know how  Lack of understanding about who patients/public can talk to  Concerns about future care if complaint is made  Communication about complaints process isn’t good enough  Commissioner should receive all complaints that we then send to the relevant provider. The response should come through the commissioner before going back to the patient (we need to see complaints to get a better understanding of what’s going on)  Make the process less formal to encourage more people to speak up. E.G. comments boards on wards  Spot checks on wards – include patients in these visits How can we encourage staff to raise concerns about patient care, when they exist and ensure they are supported? How Can We? ENCOURAGE Concerns about care SUPPORT Create CULTURE Listening Events Feedback

6. How can we all listen more effectively? We need time for active listening  Need to record what they say  do something about it!  Need to feedback what action is taken  Need to be honest – manage expectations  Org ownership, service ownership, individual staff ownership  Patient comes first every time!  need knowledge to be given to staff to understand how the NHS works to enable them to help/signpost  Good customer service – listening, communication, respect, compassion, empathy  Do we have the right processes in place to support listening/recording/acting/feedback?  Do we have the right processes in place to monitor that our providers have right culture/support listening/recording/acting/feedback  Have to combat empire building/culture  How do you focus on the nuggets of information  outside the “noise” How can we encourage everyone to raise concerns about patient care, when they exist and ensure they are supported? What would help you? Central point of contact No stupid questions/concerns: freedom to discuss anything - Support - Good communication - Independent - Confidential at initial point - Don’t know who to approach  Signposting  Peer support  Different avenues – phone, email, face to face, letter  No repercussions  Definite feedback  Need to know values – what is normal? Listening Events Feedback

7. Where is the boundary between us as commissioners and provider’s business in relation to patient experience, quality and safety? We don’t want Telford and Wrekin patients to experience organisational/professional/financial boundaries = principle  If Francis is accepted it will be the CQC assuring fundamental standards so the CCG will expect clear assurance from the CQC  If Francis is accepted – The Telford and Wrekin CCG will develop local enhanced standards for its NHS providers so would “free” CCG to define local quality priorities and redefine ownership of these  The CCG board should seek assurance on how each of its main providers is responding to Francis with particular focus on steps being taken to address cultural issues – (is this quantifiable). We want board to boards!  A convention of senior clinicians from SaTH and Telford and Wrekin CCG debating Francis as a piece of O.D. Listening Events Feedback & actions The Chief Nursing Officer’s 6Cs Framework for nursing, midwives and care staff was considered within this context with an acceptance that the 6 principles be adopted by the CCG across all staff groups and this is to be progressed through the CCGs Organisational Development Plan for 2013/14. Patient Experience Report under development to hear the voice of patient CCG Whistle blowing policy revised

8. Plan The recommendations for commissioners will be fully considered by CCG leads and any areas for focus to be identified workshop planned 12 th July Working principles to be developed through Organisational Development plan for the year. Work with Health Roundtable on patient assurance processes – what does good look like? Develop network of engagement leads pan Shropshire Develop on the Local Directors of Nursing Forum to share practice and develop joined up initiatives and implementation processes Work with providers through the Clinical Quality Review processes to gain assurance of their actions. Update report to Board on progress in October 2013.