The Francis Report: One Year On

In the year since the publication of the Francis Report NHS England has led many significant improvements to address the concerns raised in this landmark report.

Jane Cummings, Chief Nursing Officer for England and NHS England Chief Nurse said:

“The lasting legacy that NHS England can give back to the patients and families who suffered in Mid-Staffs is to make the NHS the safest healthcare service in the world.

“We need to embrace transparency and learning, unequivocally and everywhere, so as to build trust with the public and knowledge within the NHS. We need to embed compassion in every part of the NHS, placing patients’ wellbeing at the centre of every decision we make.  And we need to involve patients, their families and carers as much as possible in that process.

“We believe this is the way to drive a safety-first culture in to every corner of the NHS.  We are not there yet, but major improvement work is under way across nursing, patient safety, patient experience, transparency and quality. These latest steps on staffing, patient safety, improving experience and candour all represent another very significant leap forward.

“We can never be complacent and must continue to listen to the people we care for and to staff who are responsible for that care so we can continually improve.”

The improvements led by NHS England over the past year include:

  • Launching the Friends and Family Test, first in all inpatient wards and A&E units, and now in all maternity services, to gather real-time patient feedback on which hospitals can take immediate action to improve their patients’ experiences. The test will be rolled out to all parts of the NHS in the coming years
  • Rolling out a new plan for nursing, midwifery and care staff – the Compassion in Practice strategy, which includes the “6Cs” which are being implemented across all areas of care, training and practice.
  • Last year, NHS England’s medical director, Professor Sir Bruce Keogh, carried out a review of the quality of care and treatment provided by 14 hospital trusts that are persistent outliers on mortality indicators, developing a new patient-centred approach to investigation that has been taken on by the CQC.
  • NHS England’s Board approved the development of a network of Patient Safety Collaboratives. These will ensure everyone involved in healthcare; staff, clinicians, patients, leaders, commissioners and regulators, are able to work together in a collaborative way to assess and improve safety, to build capability, and to focus on the actions that can make the biggest difference to patients. The programme to develop Patient Safety Collaboratives includes establishing a Patient Safety Improvement Fellowship scheme to develop 5,000 Fellows within a national faculty within five years.
  • In response to the staffing guidance published by the Chief Nursing Officer and National Quality Board, every Trust in England has been directed to publish actual versus expected nurse, midwifery and care staffing levels and to clearly explain how they have decided on their staffing numbers in each ward and clinical area.
  • At the end of 2013, trusts in the North of England began regular publication of numbers of patients who develop pressure ulcers and patients that fall while in hospital. This will be combined with the results from the Friends and Family Test, the NHS safety thermometer, patient and staff experience surveys and patients stories, all in one place, to not only build up a picture of care quality but also of an excellent and open reporting culture.
  • As part of our commitment to be open and transparent about patient safety incident reporting, we have begun publishing data on never events in greater detail than ever before. The NHS in England is now one of the only healthcare systems in the world that is this open and transparent about patient safety incident reporting, particularly around never events. We are clear that we need to openly tackle these issues, not ignore them.
  • Just last month, NHS England launched the new National Patient Safety Alerting System (NPSAS) which will ensure warnings of emerging risks can be rapidly issued. As part of the new process, by April 2014 NHS England will also begin publishing monthly data on trusts who fail to confirm they have complied with the required actions of an alert within the set timeframe.
  • Quality Surveillance Groups have been put in place across NHS England’s 27 area teams and four regions, to share information and address quality of care. The groups are formed from a range of stakeholders and look at what does data such as mortality rates and soft intelligence like patient opinions tell us about where there might be concerns about the quality of care, what patients and clinicians are worried about in terms of service quality, and what can be done to investigate and address those worries. NHS England is working with the new groups as they develop to set out national guidance for collaborative quality surveillance.
  • In the last 12 months, we have begun publication of outcome data from consultants in 12 surgical specialties, with more to come, as well as more detailed data than ever before on GPs outcomes. As work to extend and link data collection from all healthcare settings progresses, we will have a fuller picture than ever before of how well health services as a whole care for patients.
  • Plans for a new national safety website which will bring together, for the first time, all of the relevant safety information and make it accessible for the NHS, patients, media and relatives alike. This will include information on staffing, pressure sores, falls and other key indicators, where possible, at ward level.

NHS England, together with CCGs, will by April 2014 set out a national level of ambition to increase the proportion and consistency of good experiences of care and reduce the proportion of poor experiences. We worked with patients and patient groups to improve the feedback we get from vulnerable patients and encourage the widespread adoption of evidence-based improvements to experiences of care.


  1. Ruth Proctor says:

    I am pleased to hear that the number of nurses on wards is to be monitered and the intention is that the number will be that of the requirement for that particular specialist ward. I have been on a very busy ward, where the Ministers in suits are heading for ICU (well provided) and the only staff on the ward I was on were myself an SLT and a student nurse. They did not come to see us!
    I do hope that this will continue.
    Also agree with new student nurses and any allied professionals to spend some of their initial training on wards.

  2. Stephen Ash says:

    The Francis Report has stimulated my colleagues and I to set up a Francis Forum at Ealing Hospital & ICO NHS Trust whereby staff can voice concerns and make suggestions about improving patient care, in a safe, supportive and confidential environment. Staff support for the Forum is gaining momentum following a series of meetings. Readers of this who wish to know more or share ideas are welcome to email me on [Link Removed]

  3. helen mcmahon says:

    Scottish health boards don’t seem to think the francis report applies up here, re staffing levels, observation levels sweeping incidents
    the under the carpet with staff conduct particularly senior managers. whistle blowing flagship policy a waste of money and effort.