Making progress after Francis

thermometer and child

Since the publication of the first Francis report into failings at Mid-Staffordshire NHS Foundation Trust, employers in the NHS have been taking action to effect change locally. There is still much to do, but vast steps have been taken to contribute to Francis being considered a byword for improvement rather than failure.

The following page shows what some employers have been doing to improve services, by:

In 2012, the King's Fund published a report, Leadership and Engagement for Improvement in the NHS, which summarised the evidence base for staff engagement and its practical importance. We know that organisations with engaged clinicians and staff achieve better outcomes for patients. This section groups activities into themes, but many of the case studies include an element of how the organisation has engaged with, and empowered its staff to deliver change.  

Putting patients first

Francis called for "patients to be the first priority in all of what the NHS does. Within available resources, they must receive effective services from caring, compassionate and committed staff, working within a common culture, and they must be protected from avoidable harm and any deprivation of their basic rights".

A desire to put patients’ needs at the heart of service provision has inspired trusts across the country to review how they operate. Effective organisational development (OD) is key to maximising workforce efficiency and effectiveness. 

This year, we have established the ‘Do OD network’ for NHS organisations to share effective practice and support those working in front line care to improve services to patients. Learn from the Do OD's 'share' network.

Listen to our podcast with Bradford District Care Trust (BDCT)- The Art of the Possible - showcasing how they ensure patients are at the heart of all they do within their OD strategy.

Using an up-skilled multidisciplinary team, Aintree University Hospital NHS Foundation Trust's Ear, Nose and Throat directorate has redesigned its services, putting patients at the centre of them. They have seen a huge increase in patient satisfaction as a result. 

Derbyshire Healthcare NHS Foundation Trust has introduced ‘Training passports’ to track and record training competencies for every post, which has had a positive impact on improving levels of competence and patient safety.

At the Heart of England NHS Foundation Trust, apprenticeships have been used to recruit trainee healthcare support workers capable of delivering high quality patient care. By doing this, the trust has found that “healthcare support workers recruited via the apprenticeship model demonstrate a commitment to upholding standards in care and are prepared to challenge poor practice.”

Developing a culture of care

Francis recommended "improved support for compassionate caring and committed nursing and stronger healthcare leadership".

Having the right staff with values, attitudes and behaviours that drive them to deliver excellent patient care is a priority for the NHS. If you are looking to embed values in your trust, the examples below, showing what others have been doing may be of interest to you.

NHS Employers is working with Health Education England to support employers and education providers to implement values based recruitment locally.

Oxford University Hospitals (OUH), University College London Hospitals (UCLH), York Teaching Hospitals, and Bradford District Care NHS Trust (BDCT) have all embarked on major programmes of work to affect culture change in their organisations. Find out how they are testing the values, attitudes and behaviours of prospective staff before they join their organisations by listening to our series of podcasts, and read OUH's case study, 'Getting the right fit'.

We are also supporting employers to work in partnership with Jobcentre Plus to recruit high calibre staff. Leeds Teaching Hospitals is one example of a trust which has benefited from this partnership, using it to recruit Clinical Support Workers with the right values and behaviours.

Since the new vision for nursing ‘Compassion in practice’ was published earlier in the year, its action areas, and the 6Cs have been embraced by employers and staff across the country. Over 250 Care Makers have been carefully selected for their dedication to Compassion in Practice and they are championing its values across the NHS. Read about how the Care Makers are putting the 6Cs into action.

Encouraging openess and transparency

Francis recommended "openness, transparency and candour throughout the healthcare system (including a statutory duty of candour), fundamental standards for healthcare providers".

Employers in the NHS are acting on the growing need for more transparency, more patient participation and better customer service.  We know that improving staff engagement helps get the most out of the NHS’ huge investment in people.

We have heard from some trusts who are publishing their staffing figures on wards, and are looking at working more closely with patients and relatives to respond to complaints.

Social media is one way of listening to and acting upon peoples' views and experiences. NHS Employers is taking an active role to promote and encourage the use of social media in the NHS as a way of engaging with staff, patients and communities. Find out more in the dedicated social media section of our website.

Creating an environment in which your staff feel able to raise concerns in the workplace, and know that they will be listened to and acted upon, is vital to patient safety. We have issued guidance and materials for employers which you can access in our raising concerns web section.

Effective leadership and accountability 

Francis called for a number of actions to improve leadership and accountability in provider organisations.

The following examples show how some organisations have engaged their leaders, and their communities in their drive to put their patients first.

Staffordshire and Stoke on Trent Partnership NHS Trust has introduced the role of 'Ambassador for Cultural Change' to champion improvements there. Hear more about it by listening to our podcast.

Find out how Devon Partnership NHS Trust engaged its senior team in the development of its Single Equality Scheme.

Guy's and St Thomas' NHS Foundation Trust has been leading the way in supporting work experience and providing employment opportunities for local people in some of the most deprived boroughs in England.

Social media allows chief executives and directors to listen to what customers, consumers, patients, staff, competitors, stakeholders, trade unions and partners are saying. It is an easy way to both get a message across and keep up to date with developments. 

Leading the way, in a project which is a first for the NHS, Salisbury NHS Foundation Trust has been successfully using social media to engage with staff and the public. Read their inspiring story 'My Trusty Little Sunflower Cream'.

The NHS Leadership Academy has developed a healthcare Leadership Model which reflects the very best in care and compassion alongside excellence in vision, direction and engagement which has been built on the values of the NHS Constitution.

Read Professor Michael West's blog on Leadership being the embodiment of culture and how it ensures direction, alignment and commitment.

Improving quality and innovation

Organisations across the country are continuing to develop and deliver their services differently, putting patients at the heart of care delivery. Some examples of how they are doing so, can be accessed via the links below.

The Royal Free London NHS Foundation Trust operates the only fully 24 hour, seven day microbiology service in England. Find out how they do it and the positive impact it is having on healthcare science service delivery and patients.

Papworth Hospital NHS Foundation Trust is taking an integrated approach to engaging its staff in its plans to move to a new state-of-the-art building 12 miles away, changing how and where they work. 

Empowering staff and working in partnership

To complement the examples provided above, this section highlights other specific areas of work being done across the NHS which you may be interested in.

Staff engagement

We know that engaged staff provide better patient care. Find out how we are supporting trusts to improve their engagement, and access toolkits, networks, shared learning examples and information about staff advocacy and the friends and families test, in our staff engagement web section.

Health and wellbeing

NHS Employers works closely with NHS organisations across the country who are implementing innovative health and wellbeing initiatives that are delivering real results for staff and for patients.  Find out who's leading the way in health, work and wellbeing innovation in our four feature trust examples. We have examples from:

  • The Walton Centre NHS Foundation Trust who implemented a health and wellbeing strategy that supports reducing sickness absence, improving the patient experience and supporting staff in improving their own health and wellbeing
  • Buckinghamshire Healthcare NHS Trust who was awarded by Healthcare People Management Association (HPMA) for excellence in improving employee health and wellbeing
  • Nottingham University Hospitals NHS Trust whose wellbeing strategy covers all aspects of staff health and has been developed in collaboration between human resources and occupational health
  • York Teaching Hospitals NHS Foundation Trust whose initiative was designed to reduce sickness absence.

Organisational development

The NHS Employers organisation is working with the NHS Leadership Academy to bring you 'Do OD'. Our Do OD web pages have been designed to provide you with inspiration, give you food for thought and allow you to Connect, Learn and Share with people around the NHS, all working to improve patient care.

The Social Partnership Forum

The Social Partnership Forum (SPF) gives organisations an opportunity to discuss and debate the development and implementation of the workforce implications of policies. 

A Francis subgroup was set up in June 2013 to enable the SPF to contribute to the Government's response to the Francis inquiry report Hard Truths: the journey to putting patients first. In volume 1, chapter 5 of the Government's response there is an entry from the Francis subgroup which sets out six key messages relating to the health workforce, on issues highlighted in the Francis Inquiry report. 

The group also looked at best practice and supported employers delivering the Francis recommendations with approaches and supporting materials. You can download best practice examples from the Social Partnership Forum website.

While the Francis group disbanded in summer 2014, SPF representatives from NHS trade unions, NHS Employers, DH, NHS England, HEE, CQC, and regional colleagues are continuing to work collectively in response to the findings and recommendations of the Francis Report to maintain a focus on the cultural aspects of the report and on the issue of staff engagement.

Personal, Fair and Diverse

With our PFD campaign, working closely with NHS England, we are aiming to create a vibrant network of champions who are committed to taking action, however small, to create a personal, fair and diverse NHS. Access case studies, and find out how you can be a PFD champion on our Personal, Fair and Diverse web section.


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