Changes in board leadership and governance in acute hospitals since Francis

Responses to Francis: changes in board leadership and governance in acute hospitals in England since 2013
Health Services Management Centre, University of Birmingham, 1 February 2018

• The Francis Inquiry concluded that the board at Mid Staffs Hospital had failed in its duty to monitor, understand, and respond to warning signs about poor care. This report sets out findings from a national survey of all NHS hospital board members in England, and case study research in six hospital trusts into changes in Board leadership and governance.
• The research found that many trusts had revised their policies on handling and responding to complaints, and on the investigation, reporting and learning from incidents. Likewise, many had developed new and enhanced approaches to staff engagement, ‘speaking up’ (or whistle-blowing), something that we know from prior research is linked with a healthy hospital culture likely to enable safer and higher quality care.

Whistleblowing in the NHS

NHS whistleblowing procedures in England
House of Commons Research briefing, 18 September 2015

• An outline of the current rights and procedures for NHS staff to raise concerns about safety, malpractice or wrongdoing at work including responses to the Francis Report.

Progress after the Mid Staffs inquiry

Culture change in the NHS: Applying the lessons of the Francis Inquiries
DH 11 February 2015

• This report Sets out the progress made in applying the lessons learned from the failings at Mid Staffordshire NHS Foundation Trust (Francis Inquiry). Each chapter sets out the key areas where further action is needed to ensure that safe, effective and compassionate care is the norm.
• The online supporting annex sets out in detail the substantial progress made against the 290 recommendations of the Public Inquiry. 
• See also Freedom to Speak Up Review - report of an inquiry by Sir Robert Francis on whistleblowing across the NHS.

"Hard Truths" guidance on publishing nurse staffing levels

Guidance issued on Hard Truths commitments regarding the publishing of staffing data
NHS England and Care Quality Commission, 1 April 2014

• Joint guidance to Trusts on the delivery of the ‘Hard Truths’ commitments associated with publishing staffing data regarding nursing, midwifery and care staff levels.
• Staff numbers will need to be displayed on boards outside all inpatient ward areas. 
• The guidance also covers the frequency with which Boards and Trusts need to display and evaluate staffing data and publish their reports online, and the dates when stock takes of their progress will be undertaken.

The Francis Report: one year on

The Francis Report: one year on
Nuffield Trust, 6 February 2014

• This report explores how acute trusts are responding to the Francis Inquiry report, one year on from Robert Francis QC’s original report into the failings in Mid Staffordshire hospitals and offers a snapshot into how acute trusts have responded to the Francis Inquiry Report.
• See also the DH Press release

Hard truths - the government recommendations from the Francis inquiry

Hard Truths: the journey to putting patients first - government response to Staffordshire NHS FT public inquiry

DH, 19 November 2013
(These reports builds on the government’s initial response to the Francis enquiry: Patients First and Foremost, March 2013).

• The reports explain the changes that have been put in place since the initial response, and set out how the whole health and care system will prioritise and build on this. Volume 2 outlines the responses to each of the 290 recommendations made by the public inquiry.
• Ministers have rejected nine of Robert Francis’ 290 recommendations, accepted 20 in part and 57 in principle only. Recommendations include:
• Statutory duty of candour on organisations and professional duty on individuals 
• Trusts that don’t stick to the duty of candour face losing their litigation cover.
• Trusts also face a new “willful neglect” offence.
• There will be no centrally-set, mandatory nurse to patient ratios, but there will be guidance and tools for setting staffing levels and trusts will have to publish regular ward data on staffing.
• Regular publication of patient safety data 
• Greater senior involvement in complaints handling 
• Fit and proper persons test for Board members and greater performance management of very senior managers 
• A 'Clinical Bureaucracy Index' for trusts and Concordat between national bodies to reduce bureaucracy.
• Read the NHS Confederation reaction and briefing.
• Read the speech given by Jeremy Hunt  - Learning lessons of Mid Staffordshire and the importance of building a culture of compassionate care

Website - Mid Staffordshire NHS Foundation Trust public inquiry: government response http://francisresponse.dh.gov.uk/

• The website created for the response has five key categories with links to each for a summary, each with sub-links. They are:
• Compassion and care http://francisresponse.dh.gov.uk/compassion-and-care
• Values and standards http://francisresponse.dh.gov.uk/values-and-standards
• Openness and transparency http://francisresponse.dh.gov.uk/openness-and-transparency
• Leadership http://francisresponse.dh.gov.uk/leadership
• Information http://francisresponse.dh.gov.uk/information
• See recommendations of interest to 46 different organisaitons and groups including CCGs , NHS providers, social care

Berwick review into patient safety

A promise to learn – a commitment to act: Improving the Safety of Patients in England

National Advisory Group on the Safety of Patients in England, DH, 6 August 2013

• Professor Don Berwick (founder and former president of the Institute for Healthcare Improvement),  was asked to produce a report to highlight the problems affecting patient safety in the NHS following the findings of the Francis Report into the breakdown of care at Mid Staffordshire Hospitals, and to make recommendations to address them.
• Ten recommendations are as follows:
• 1. The NHS should continually and forever reduce patient harm by embracing wholeheartedly an ethic of learning.
• 2. All leaders concerned with NHS healthcare – political, regulatory, governance, executive, clinical and advocacy – should place quality of care in general, and patient safety in particular, at the top of their priorities for investment, inquiry, improvement, regular reporting, encouragement and support.
• 3. Patients and their carers should be present, powerful and involved at all levels of healthcare organisations from wards to the boards of Trusts.
• 4. Government, Health Education England and NHS England should assure that sufficient staff are available to meet the NHS’s needs now and in the future. Healthcare organisations should ensure that staff are present in appropriate numbers to provide safe care at all times and are well-supported.
• 5. Mastery of quality and patient safety sciences and practices should be part of initial preparation and lifelong education of all health care professionals, including managers and executives.
• 6. The NHS should become a learning organisation. Its leaders should create and support the capability for learning, and therefore change, at scale, within the NHS.
• 7. Transparency should be complete, timely and unequivocal. All data on quality and safety, whether assembled by government, organisations, or professional societies, should be shared in a timely fashion with all parties who want it, including, in accessible form, with the public.
• 8. All organisations should seek out the patient and carer voice as an essential asset in monitoring the safety and quality of care.
• 9. Supervisory and regulatory systems should be simple and clear. They should avoid diffusion of responsibility. They should be respectful of the goodwill and sound intention of the vast majority of staff. All incentives should point in the same direction.
• 10. We support responsive regulation of organisations, with a hierarchy of responses. Recourse to criminal sanctions should be extremely rare, and should function primarily as a deterrent to wilful or reckless neglect or mistreatment.
• Watch Don Berwick presents the findings from his review into patient safety on the Kings Fund website here.

Lines of defense against poor quality care - Findings of the Francis report

Patient-centred leadership
Kings Fund, 23 May 2013

• A summary of the main findings of the Francis Inquiry into the failings of care at Mid Staffordshire in relation to NHS leadership and culture. 
• The report sets out what needs to be done to avoid similar failures in future, focusing on the role of three key 'lines of defence' against poor-quality care: 
• frontline clinical teams, 
• the boards leading NHS organisations, and 
• national organisations responsible for overseeing the commissioning, regulation and provision of care.

Lessons from the Francis Inquiry around patient centred leadership

Patient-centred leadership, rediscovering our purpose 
Kings Fund, 23 May 2013

• This report summarises the main findings of the Francis Inquiry into the failings of care at Mid Staffordshire in relation to NHS leadership and culture. It sets out what needs to be done to avoid similar failures in future, focusing on the role of three key 'lines of defence' against poor-quality care: frontline clinical teams, the boards leading NHS organisations, and national organisations responsible for overseeing the commissioning, regulation and provision of care.
• Key findings
• The leadership of the NHS at a national level needs to create conditions in which local organisations have the freedom to deliver consistently high standards of care and where the needs of patients come first. 
• The quality of care provided by NHS organisations should, first and foremost, be a corporate responsibility under the leadership of boards, who must lead by example by focusing on the quality and safety of care. 
• Leaders need to value and support frontline staff and ensure the main focus is on patients and their care. 
• Leadership development should give priority to supporting leaders at all levels to be patient-centred and to ensure that staff have the time and resources required to deliver high-quality care. 
• Patient leaders should work alongside NHS leaders to support the transformation called for in the Francis Inquiry report

Response to the Francis report

Government’s response to the Francis report 
DH 26 March 2013

• Parliamentary statement setting out the Government’s response to the Mid Staffordshire NHS Foundation Trust Public Inquiry. (The Francis report)
• Highlights include: 
• establishment of a new regulatory model under an independent Chief Inspector of Hospitals working for the CQC;
•  a new statutory duty of candour for providers;
• the CQC will no longer be responsible for putting right any problems identified in hospitals (enforcement powers will be delegated to Monitor and the Trust Development Authority); 
• no hospital will be rated as good or outstanding if fundamental standards are breached; 
• new legal sanctions at a corporate level for organisations who wilfully generate misleading information or withhold information they are required to provide.

The Francis report

Report of the Mid Staffordshire NHS Foundation Trust public inquiry
6 February 2013

• The Final report of the public inquiry into the commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire hospital between January 2005 and March 2006.
• See also The Francis Inquiry: creating the right culture of care (Kings Fund)
• The timeline leading up to the Mid Staffs inquiry is described in a BMJ article "Who knew what, and when, at Mid Staffs?" BMJ 2013;346:f726 6 February 2013