NHS Commissioning Board promises fundamental change in response to Francis Report

This is a day for the NHS to reflect fully on the harrowing experiences of those personally affected by the failures at Mid Staffordshire NHS Foundation Trust.  The NHS Commissioning Board (NHS CB) takes on a key leadership role in the NHS in England from April and is absolutely committed, together with all other organisations in the health system, to addressing the failings that allowed these events to develop unchecked.

The only acceptable legacy of the Francis Report is that the NHS changes.  We strongly welcome the Government’s initial steps on improving safety, listening to patients’ complaints, and improving regulation and training.  Now we must develop our own detailed response to the Francis Report recommendations to bring about lasting improvements.

As an immediate first step, the NHS CB Medical Director, Sir Bruce Keogh, is to conduct an investigation into the five hospitals who have been outliers on Summary Hospital-level Mortality Indicator (SHMI) data for two successive years to 2012. These five hospitals are:

  • Colchester Hospital University NHS Foundation Trust
  • Tameside Hospital NHS Foundation Trust
  • Blackpool Teaching Hospitals NHS Foundation Trust
  • Basildon and Thurrock University Hospitals NHS Foundation Trust
  • East Lancashire Hospitals NHS Trust

Sir Bruce will make further announcements shortly about the terms of reference for this work and any further hospitals to be looked at.

Action on the concerns previously identified is already underway or planned (see below).  There is much more to do but we hope people can see that the journey has begun. We are determined to repair the damage to public confidence.

  • Standards & methods of compliance: there was not sufficient clarity around standards on safety and patient care. First step:Don Berwick, an internationally healthcare expert, will examine zero tolerance of harm. A national quality dashboard will be developed to identify safety failures in providers.
  • Openness, transparency and candour: In Mid Staffs, early warning systems were immature and ineffective. The NHS CB plans far greater transparency, honesty and openness. First step: We have introduced a duty of candour into the NHS contract.
  • Improved support for compassionate nursing: In Mid Staffs, the staff behaved in ways that were a total betrayal of what the NHS stands for. The NHS CB values kindness, thoughtfulness and compassion in NHS staff as much as their technical skills.  We will work with the whole NHS, especially Health Education England, to refocus training and recruitment on these values. First step:Implementation of “compassion in practice” our nursing strategy
  • Strong, patient-centred leadership: In Mid Staffs, the NHS failed to listen to patients. The NHS CB will give patients much more clout so they are at the centre of decision-making and are always listened to. First step:Thefriends-and-family test will gather the views of all patients on whether they recommend a hospital to someone close to them. The NHS Leadership Academy will bring together clinical and management leadership.
  • Accurate, useful and relevant information: Everything we know, we will share – so the public have better information about what is going on. First step:We will begin publishing consultant level outcomes data in ten surgical specialties, including mortality rates.
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  1. Hamish Macdonald says:

    I fully concur with Rosemary’s (my wife) comments but would like to comment on ways forward.

    Francis advises culture change but this will not be accomplished by regulation/direction from above which has already been tried and proved unsatisfactory as shown by the award of Foundation status in Mid Staffordshire not long before all the bad news emerged. It develops in the opposite direction and represents the overall attitude of front line staff who are the real NHS. However, responsive systems empowering clinicians in the widest sense (medical, nursing etc) are essential for it to flourish and this is the change we must pursue.

    Assessment of quality starts with patient feedback comprehensively canvassed and continuously monitored to avoid distortion by selective reporting, plus carefully targeted audit.. Wards must have clear leaders – the ward sister and consultant colleagues – with autonomy appropriate to the local level, clear upward channels of communication and accountable for outcome. Efficient use of budget to achieve maximum patient benefit should be the overriding concern. As standards rise so will staff morale, pride and ambition. New staff will absorb principles of good practice and pass them on. This model is not new and is still to be found in many hospitals either at institutional or departmental level. It must develop at all levels up to the Board itself.

    My own view, coloured by six years as medical director on top of a consultant career at one of our largest teaching hospitals, is that senior clinician’s skills are of most use where they developed and it is difficult to do justice to both simultaneously. My preference would be a consultative process combining executives with representative senior clinicians. The body would not have executive powers but by debating and hopefully agreeing ways forward, will give a strong example to the board. All parties have to justify their positions in front of equally senior and experienced colleagues with agreed positions being widely accepted as the best way forward. All will feel valued and encouraged to take responsible positions. Institutional pride and ambition will develop and filter down to ward level. Accountability would be taken for granted as the price of devolved power.

    In this way whistle-blowers should become unnecessary with problems being identified and tackled at a much earlier stage. This is a variant on the clinician led service but need not exclude individual clinicians taking up senior management roles. Successful change occurs in positive environments which was the strength of the NHS in the past but has been diluted more recently, even died out in some quarters. Regulation from above should be relegated to become a last resort as a potential solution for a problem which persists despite best efforts.

  2. rex hayden says:

    I speak as a retired GP and experience as a patient in NHS hospitals several times in the last 14 years. Only two things to do…first bring back a daily doctors ward round, accompanied by nurses, and second, to bring back enrolled nurses not needing high school qualifications, trained in the wards, and having a career structure, whilst retaining the present RGN`s.

  3. Eve Dale says:

    I would agree with Rosemary MacDonald’s second comment. Many retired senior nurses would have much to offer in voluntary positions in the NHS. How many of these well qualified people are approached to apply for these positions? It is time we used the skills and experience of retired clincians as volunteers in agencies such as CQC and Monitor.

  4. Paul Timmins says:

    I like the idea of use of friends and family test but would want to be assured that there was no way that patient responses could be cherry picked or fudged in any other way. The stakes are high for hospitals here and there will be an inevitable temptation by a few to tamper with the raw data. So the challenge in my humble opinion will be to get valid and accurate data.
    If standards associated with patient care are introduced I feel that they should be tied as closely to patient day to day experiences/ entitlements/ rights as possible. This could be achieved by asking patients directly whether for eg they received specific feature of care, as defined in any standards
    Eg timely medication, regular inquiry into their medical and care needs by staff on ward, actual delivery of care oriented services eg was help available for toilet needs when needed, help with feeding and drinking etc,
    Advantage of this sort of data on ward by ward basis collated and reflected upon by staff could be used to improve services as data would point to specific areas for improvement data could also be collated across services centres and whole hospitals to identify resources needed to put things right.
    As in comment above need for honest and accurate data would be paramount

    This type of data gathering would allow for evaluation of care provided and any improvements made in manner which beats the “do you feel” type questionnaire. This approach gets at what patients actually get…. Perhaps there are better forms of verification of services but observation which is most valid is too expensive other than for special expert inspections.
    Thank you for this opportunity to comment on your proposals

  5. rosemary macdonald says:

    This is a postscript!
    retired clinical people have another advantage–they know how to undertake “visits” to assess care
    especially those of us who undertook that task professionally. We are able to blend into the background and
    access places in hospitals where lay persons cannot.
    I have witnessed brilliant care recently in a hospital and very poor care.

  6. rosemary macdonald says:

    This response is a step in the right direction.
    I email as a former Consultant and Postgraduate Dean, now retired but Chair of a Hospice.
    ALL members of staff are involved—the consultants have a responsibility to be frank and candid
    about patient care or the lack of.

    Medical Schools should take heed too.

    But I do wonder if nursing has lost its way.

    More clinical retirees should be non executives of NHS Boards which currently have too many who just
    do not understand the ramifications of the totality of the NHS and most certainly have no
    comprehension of what I call “the third dimension”—all the subtleties which comprise quality in the NHS