Francis Inquiry Recommendations

What are the implications for all of us in our everyday work?

Some figures…

• >1 million pages of documentary material

• 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

A negative culture?PRESSURE

Targets Finance

FT status Jobs

REACTION Fear

Low morale Isolation

Disengagement No openness

BEHAVIOUR Uncaring

Unwelcoming Bullying

Keeping head down

HABITUATION Tolerance

Denial External reassurance

Someone else’s problem

Recommendations

• Common values • Fundamental standards • Openness, transparency and candour • Compassionate, caring, committed nursing • Strong patient centred healthcare

leadership • Accurate, useful and relevant information • Culture change not dependent on

Government

Values – Clarity and Commitment

• Do We Put Patients’ first in all we do?• Do we protect patients from avoidable harm?• Are we open & honest with ourselves when

things have not gone to plan?• Are we open & honest with patients when things

have not gone to plan or we have not provided a good experience?

• Do we know how to raise our concerns about patient safety?

Fundamental standards

• What patients and the public see & experience are the fundamental standards (care, compassion, communication, commitment to effective and well co-ordinated care)

• Is everyone aware of & understand the fundamental standards that the CQC hold us to account as part of regulation?

• If you are not aware – would you know where to go for support in getting a better understanding?

Fundamental standards - Examples

• Prescribed medication given • Food and water to sustain life &

assistance when needed• Patients environment and equipment kept

clean • Assistance where required provided to go

to the toilet• Consent for treatment obtained

Openness, Transparency and Candour

• Openness: enabling concerns and complaints to be raised freely and fearlessly, and questions to be answered fully and truthfully

• Transparency: making accurate and useful information about performance and outcomes available to staff, patients, public and regulators

• Candour: informing patients where they have or may have been avoidably harmed by healthcare service whether or not asked

Compassionate, caring and committed nursing

• Aptitude assessment on entry to training including ability to demonstrate compassion

• Hands on experience a requirement prior to training

• Named nurse (and doctor) responsible for each patient

• Code of conduct and common training standards for HCSWs

Strong, patient-centred leadership

• Effective clinical & managerial leadership of teams – evidence demonstrates it is linked with better outcomes for patients

• Leadership development & Aston team effectiveness programmes – do we know about them? Are we getting involved?

• How do we use patient feedback to improve our practice and the way we do things?

Accurate, useful and relevant information

• Individual and collective responsibility to develop performance measures

• Do we use data & information to improve our practice and our services?

• Do you know what measures your department and division use so that you know how well you are doing as a team?

What is the Trust doing already?

• “We care” programme – are you involved in the values into action events in your division?

• Shared purpose framework of competencies around person-centred, safe & effective care

• Executive Patient Safety Visit programme (Culture)

What is the Trust doing now?• Leadership programme based on

competencies within Shared Purpose Framework (Nursing and other clinical leaders)

• Ward staffing establishment in process of annual re-review (Nursing)

What is the Trust doing already?

• Revalidation of doctors to include 360o

feedback from their team, clinical outcomes and patients (Comments and complaints)

• Preparation for the launch of “friends and family test” for in-patients and those attending A&E – going live in April

• Triangulation of data from complaints, concerns, serious incidents and claims

What does our Board consider to be the priorities?

• listening & responding to feedback from patients and the public

• Listening & responding to staff and encouraging them to raise concerns about any aspect of clinical care

• Ensuring that we are listening and responding to feedback from staff who are in training both pre-registration and post registration

• Ensuring teams have the opportunity of undertaking the Aston Team working approach to clarify roles, responsibilities, accountabilities, approaches to improving communication amongst the team

What does our Board consider to be the priorities?

• Reviewing our approach to the publication of performance information on the public web-site – strengthen accountability to public

• Exploring the meaning of the “duty of candour” and outlining our approach to openness and disclosure of information

Notes on Hospitals, Nightingale F, 3rd ed 1863, Longman Green Roberts & Green

Florence Nightingale, Notes on Nursing (1860) pages 92-93