Francis Report: Insights & Actions for Improved Patient Care

1. Appendix 1 Francis report into care at Mid Staffordshire Foundation Trust – briefing and discussion March 2013

2. 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 communications@cddft.nhs.uk

3. See Staff Net for links to the report, and a summary of the report.

4. 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;

5. 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.

6. 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

7. 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

8. 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 undertaken Additional actions proposed by ECL at its meeting on 7 February Actions discussed at the extraordinary Board meeting on 13 February

9. 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

10. Additional actions proposed by ECL Understand and describe the position of the organisation in relation to key Francis concerns Development of clinical engagement to create a clinical mandate for service change Audit and develop robust arrangements for internal cascade Tackle unprofessional behaviours Link 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

11. 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

12. 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!

13. 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?

14. 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