The Government has published its response to the Francis inquiry report.
More openness, greater accountability and a relentless focus on safety will be the cornerstones of an NHS which puts compassion at its heart, Health Secretary Jeremy Hunt announced today. The plans, set out in the Government’s response to the Inquiry into the failings at Mid Staffordshire NHS Foundation Trust, build on the cultural change already taking place in the wake of the hospital scandal.
The Government has already instigated a number of changes following the Inquiry’s report published in February, most notably introducing a new hospital inspection regime and legislating for a duty of candour on NHS organisations so they have to be open with families and patients when things go wrong.
Today’s response builds on this and sets out a detailed response not only to the Inquiry but also to five expert independent reports on safety, complaints, bureaucratic burdens, support workers and trusts with the worst mortality rates. The response also comes as new figures show that, following the Inquiry’s report and Government action to date, hospitals are already planning to hire more than 3,700 extra nurses over the coming months.
Key proposals for consultation to be announced today would see all NHS organisations and professional staff obligated to be open with patients when things go wrong. If a hospital had not been open with patients and their families following a patient safety incident, its indemnity cover for that compensation claims could be reduced or removed. This would give a strong financial incentive to hospitals to be open about patient safety incidents. Similarly, the General Medical Council, the Nursing and Midwifery Council and the other professional regulators will introduce a new explicit and consistent professional duty of candour for doctors, nurses and other health professionals, making clear a requirement to be open with patients and families, whether the incident is serious or not. Health professionals will have to be candid with patients about all avoidable harm and the guidance will make clear that obstructing colleagues in being candid will be a breach of their professional codes. Speaking up quickly may also be considered to be a mitigating factor in a conduct hearing and this will further encourage individual candour. Inspired by normal practice in the airline industry, “near misses” of serious harm will also be subject to a professional duty of candour, fostering an NHS culture in which reporting and learning from mistakes is the norm.
Health Secretary Jeremy Hunt said:
I do not simply want to prevent another Mid Staffs. I want our NHS to be a beacon across the world not just for its equity, but its excellence. I want it to offer the safest, most compassionate and most effective care available anywhere – and I believe it can.
Today’s measures are a blueprint for restoring trust in the NHS, reinforcing professional pride in NHS frontline staff and above all giving confidence to patients. I want every patient in every hospital to have confidence that they will be given the best and safest care and the way to do that is to be completely open and transparent.
New changes in response to the independent recommendations include:
- Safe staffing: from next April, all hospitals will publish staffing levels on a ward-by-ward basis together with the percentage of shifts meeting safe staffing guidelines. This will be mandatory and will be done on a monthly basis. By the end of next year this will be done using models approved independently by NICE.
- Boards will review the evidence for their staffing numbers in public at least once every six months.
- A new national safety website will publish all the information relevant to safety in every hospital in the country on a monthly basis, so that patients have the same information about their hospitals that the system has.
- A new national patient safety programme across England will spread best practice and build safety skills across the country. NHS England will start the programme in April 2014 and will bring together frontline teams, experts, patients, commissioners and others to tackle specific patient safety problems, develop and test solutions, and learn from each other to improve safety.
- Five thousand patient safety fellows will be trained and appointed by NHS England within five years, to be champions, experts, leaders and motivators in patient safety. The fellows could be anyone, from a frontline nurse to a senior manager, who has demonstrated a commitment to and success in delivering quality improvement.
- Quarterly complaints reporting and better complaints information: Trusts will report quarterly on complaints data and lessons learned and the Health Service Ombudsman will increase significantly the number of cases she considers. In addition, all hospitals will be required to set out clearly how patients and their families can raise concerns or complain, with independent support available from their Healthwatch or alternative organisations.
- Better reporting of safety incidents: Experts will be asked to advise the Government on how to improve reporting of safety incidents, including whether the statutory duty of candour on organisations should cover incidents of death and severe harm, or death, severe and moderate harm.
- A new criminal offence for wilful neglect: the Government will legislate at the earliest available opportunity to make it an offence to wilfully neglect patients – so that organisations and staff, whether managers or clinicians, responsible for the very worst failures in care are held accountable.
- A new Fit and Proper Person’s Test which will enable the Care Quality Commission to bar unsuitable senior managers who have failed in the past from taking up individual posts elsewhere in the system.
- Time to care: Every national NHS organisation has signed a compact to reduce the national bureaucratic burden on frontline organisations and frontline staff dramatically, freeing up hospitals to focus on their local populations and freeing up time for staff to care for patients.
- A new Care Certificate to ensure that Healthcare Assistants and Social Care Support Workers have the fundamental training and skills needed to give good personal care to patients and service users. The Chief Inspectors will ensure that employers are using the Disclosure and Barring Service to prevent unsuitable staff from being re-employed elsewhere.
- Every hospital patient should have the names of a responsible consultant and nurse above their bed. And as announced last week as part of the agreement with GPs, starting with over-75s from next April, there will be a named accountable clinician for out-of-hospital care for all vulnerable older people.
In total, the Government has accepted 281 out of 290 recommendations, including 57 in principle and 20 in part (meaning the recommendation has been accepted with some differences or new ideas relating to how it will be delivered). Progress against the report as a whole will now be reported to Parliament on an annual basis to ensure rapid progress against delivering the recommendations.
Since the initial response to the inquiry in March, progress includes:
- The Care Quality Commission has appointed three Chief Inspectors of hospitals, adult social care and primary care.
- In the Care Bill, the Government has introduced a new criminal offence for care providers that supply or publish certain types of information that is false or misleading. This offence will also apply to directors and senior managers where an organisation has committed the offence, rather than just organisations.
- Expert inspections of hospitals with the highest mortality rates, led by the NHS Medical Director, revealed unacceptable standards of care. Eleven hospitals were placed into ‘special measures’ to put them back on a path to recovery and then to excellence.
- Inspection of eighteen Trusts has begun, and will be completed by Christmas. By the end of 2015 the CQC will have inspected all acute Trusts.
- The Care Quality Commission has consulted on a new system of ratings with patient care and safety at its heart.
- Legislation to introduce a responsive and effective failure regime which looks at quality as well as finance is progressing through Parliament.
- The Government is legislating to give greater independence to the Care Quality Commission.
- The Care Quality Commission has conducted a major consultation on a new set of fundamental standards: the inviolable principles of safe, effective and compassionate care that must underpin all care in the future.
- The fundamental standards will enable prosecutions of providers to occur where patients have been harmed because of unsafe or poor care, without the need for an advance warning notice. This will ensure that the current regulatory gap identified in the Inquiry is filled.
- NHS England has published guidance to commissioners, Transforming Participation in Health and Care, on involving patients and the public in decisions about their care and their services.
- The Health and Safety Executive has brought a prosecution against Mid Staffordshire Foundation Trust for the death of a patient during the period of the failings at the Trust. This case is awaiting sentence.
- For the first time, NHS England has published clinical outcomes by consultant for ten medical specialties and has also begun to publish data on the Friends and Family Test.
- New nurse and midwifery leadership programmes have been developed from which 10,000 nurses and midwives will have benefitted by April 2015. Compassion in Practice has an action area dedicated to building and strengthening leadership.
- New approaches to nurse training, where nurses work as healthcare assistants, are being piloted.
- A new fast-track leadership programme to recruit clinicians and external talent to the top jobs in the NHS in England has been launched, including time spent at a world-leading academic institution.
- By the end of the year, 96 per cent of senior leaders and all Ministers at the Department of Health will have gained frontline experience in health and care settings.
In addition to the Francis Inquiry the government has responded to the following independent reports:
- Review into the Quality of Care and Treatment Provided by 14 Hospital Trusts in England, led by Professor Sir Bruce Keogh, the NHS Medical Director in NHS England.
- The Cavendish Review: An Independent Review into Healthcare Assistants and Support Workers in the NHS and Social Care Settings, by Camilla Cavendish.
- A Promise to Learn – A Commitment to Act: Improving the Safety of Patients in England, by Professor Don Berwick.
- A Review of the NHS Hospitals Complaints System: Putting Patients Back in the Picture by Rt Hon Ann Clwyd MP and Professor Tricia Hart.
- Challenging Bureaucracy, led by the NHS Confederation.