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Appendix 1
Francis report into care at Mid Staffordshire Foundation Trust – briefing and discussionMarch 2013
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Background
Francis report was published in February
All organisations have been asked to hold events with staff to discuss the report, and the Trust is organising these
In the meantime, the Board and ECL have asked chairs of all meetings to agenda a minuted discussion about the report and feedback via minutes
Minutes of the discussion should also be sent to the communications team [email protected]
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See Staff Net for links to the report, and a summary of the report.
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Mid Staffs - the cause
A culture focused on doing the system’s business – not that of the patients;
An institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern;
Standards and methods of measuring compliance which did not focus on the effect of a service on patients;
Too great a degree of tolerance of poor standards and of risk to patients;
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Mid Staffs - the cause
A failure of communication between the many agencies to share their knowledge of concerns;
Assumptions that monitoring, performance management or intervention was the responsibility of someone else;
A failure to tackle challenges to the building up of a positive culture, in nursing in particular but also within the medical profession;
A failure to appreciate until recently the risk of disruptive loss of corporate memory and focus resulting from repeated, multi-level reorganisation.
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Francis recommendations
The merger of the regulation of care into one body - two are currently involved
Senior managers to be given a code of conduct and the ability to disqualify them if they are not fit to hold such positions
Hiding information about poor care to become a criminal offence
A statutory obligation on doctors and nurses for a “duty of candour” so they are open with patients about mistakes
An increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors
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Named clinicians responsible for each inpatient, every shift
Supervisory ward sisters
Registration scheme supported by common standards and training for HCAs
More recognition of needs of elderly – registered older person’s nurse
NHS leadership college
Trusts to report regularly on progress on Francis recommendations
Francis recommendations
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Trust action so far
Discussion at all key meetings, and relevant actions identified
These are in three groups:Actions which are relevant to the Francis agenda and already being undertakenAdditional actions proposed by ECL at its meeting on 7 FebruaryActions discussed at the extraordinary Board meeting on 13 February
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Relevant actions already under way
Quality impact assessments on efficiency improvements in clinical services
A review of nursing workforce numbers by the Director of Nursing
Organisational development programme focusing on developing clinical engagement and management, led by the Director of HR and OD
“nurse in charge programme” investment identified to make ward managers supernumerary
A review of communications and engagement with staff.
More inclusive approach to business planning processes, including risk
Stakeholder events held to develop the organisation’s strategy to deliver best outcomes, best experience, best efficiency and best workforce
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Additional actions proposed by ECL
Understand and describe the position of the organisation in relation to key Francis concernsDevelopment of clinical engagement to create a clinical mandate for service changeAudit and develop robust arrangements for internal cascade Tackle unprofessional behavioursLink professional accountability into clinical governance arrangements“Recruit for compassion”Robust arrangements for communicating risk, as part of handover and consider return to the “night report”An explicit compact for all staff and for leaders including accountability, candour and governance
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Actions discussed by the Board
Use Francis as an opportunity to create a consistent, effective, high level of care
Strong proposals for more feedback from patients and from their friends and families
5 year quality strategy for the Trust, which reflects the NHS constitution
Ensure an open respectful atmosphere where patients and staff can provide honest feedback, and improve responsiveness when issues are raised
Develop the next stage of our strategic direction, focusing on quality in more granular detail
Improve the accountability of care groups to the Board, and improve nurse representation in the care groups
Review the effectiveness of benchmarking against Trust peers
Build on recent improvements in relationships with stakeholders
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Francis – listening to staff
All meetings in March to agenda Francis and feed back
Directors will be attending a proportion of staff meetings during April
Invitations to a “cross section” of staff to meetings in May to discuss Francis and quality
Further listening events planned
Make sure staff are given the chance to attend!
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Points for discussion today
What are the lessons from Francis for this group?
Are there actions the group should be taking?
Are there specific recommendations that apply to this group?
Are there issues the group wants to raise with the Board?
Are there any other issues you would like to raise?
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Next steps
Comments under each of the five questions to be written up and included in the minutes
Also to be sent to the communications team
Look out for invitations to other listening events
This report represents “not the end but the beginning of a journey towards a healthier culture in the NHS where patients are the first and foremost consideration of the system and all those who work in it. It is the individual duty of every organisation and individual within the service to read this report and begin working on its recommendations today.”
Robert Francis
