The Government response to Francis

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26 / 3 / 2013 3.25pm

The response from the Government recognises that the inquiry focused on failings at one hospital between 2005 and 2009 and asserts that the whole health and care system needs to listen, reflect and act to tackle the key challenges of culture and behaviour.

It states that action is needed across all levels if we are to see systemic and sustainable change happen and refers to four key groups that are essential to creating a culture of safety, compassion and learning that is based on co-operation and openness:

  1. patients and service users, their friends, family and advocates
  2. frontline staff, working together as effective teams
  3. the leadership at all levels in provider organisations, including the board
  4. the external structures - including commissioners, regulators and other local scrutiny bodies, special health authorities and Department of Health.

Read the full Government response.

Read NHS Employers and the NHS Confederation's response in our media centre.

Summary of the Government's response

The response is divided into five chapters. We have provided some headlines under each of the chapter headings for you below.

  1. Preventing problems
  2. Detecting problems quickly
  3. Taking action promptly
  4. Ensuring robust accountability
  5. Ensuring staff are trained and motivated

1) Preventing problems

The challenge laid down for boards and leaders across the system is to create an environment where staff feel supported - enabling openness and compassion.

There are some actions that have been created to prevent poor care occurring in the first place:

  • Creation of a new Chief Inspector of Hospitals: The Chief Inspector has been described as the nation's whistleblower and focused on patients.
  • Publishing a revised NHS Constitution.

2) Detecting problems quickly

  • Expert-led inspections to inform the Chief Inspector.  Designed to follow the example of OFSTED within education, the new approach will provide a credible, respected and independent arbiter of care.
  • Stop the use of clauses that intend to prevent public interest disclosure.
  • Review best practice on complaints.
  • Extend the publication of outcomes from heart surgery to other specialities.
  • Further work will be undertaken on standardising quality accounts.
  • A contractual duty of candour is included in the NHS Standard. Contract 2013/14 for all providers to be open and honest with patients when things go wrong. The DH intend to go further and introduce a statutory duty of candour on providers as well as explore what professional regulators can do.

3) Taking action promptly

  • The CQC will work with partners to draw up a new set of fundamental standards which the basic standards of care should not fall beneath.
  • The Chief Inspector will be able to issue a public call to action to the hospital and the regulators responsible for the oversight. If the quality (patient safety, care and finance) issues cannot be resolved the Chief Inspector can initiate a failure regime.
  • The NHS Trust Development Authority has the ability to agree plans for achieving FT status beyond the initial 2014 date if in the interests of quality and sustainable services for patients.

4) Ensuring robust accountability

The response makes clear that it is the responsibility of providers and commissioners to identify and resolve problems at a local level but it accepts that the national machinery is not always as aligned and responsive as it should be.

The government is proposing:

  • The Chief Inspector will refer criminally negligent practice in hospitals  to the Health and Safety Executive, who will consider whether criminal prosecution is necessary.
  • The Chief Inspector will have a role in ensuring that  providers apply the referral protocols from the Disclosure and Barring service consistently. 
  • A review by the Law Commission, already underway, intends to overhaul the out of date legislative framework that can restrict professional regulators from being more proactive. The NMC and GMC are also looking at processes that are within their gift to see how they can become more responsive.
  • Introduction of a national barring list for managers, based on the barring scheme for teachers, but recognising that any such scheme should be developed carefully and is suggesting drawing up proposals to consult upon.
  • Consideration is being given to whether an assured voluntary register should be introduced; whether the current guidance on severance payments is proportionate. 

5) Ensuring staff are trained and motivated

This section covers various aspects of employment practice and makes suggestions as to how across the system we can put things in place to support staff to deliver high quality, compassionate care.  It also states the importance of staff engagement activity at a local level, using the staff survey and listening to staff to help drive local action.

  • Treating staff well: this covers striving for excellence in recruitment, induction, training and appraisal at a local level and references the well known evidence base. See our staff engagement and health and well being resources for more information on this.
  • Staffing levels: work will commence to develop evidence based guidance around staffing levels that can be used by providers.
  • Making time to care: ensuring that we use technology to help free up staff from duplication created by systems and paperwork.
  • Rewarding high quality care: The Government response also refers to pay and contractual issues and strongly encourages employers to use the full flexibilities in existing pay and contracts so that pay progression is linked to quality of care and not timed served. The NHS Employers organisation has been asked to support you with this by working with you on new model performance frameworks, which will place greater emphasis on the quality of care, including the important NHS values of compassion, dignity and respect.
  • Recruitment and training: Health Education England (HEE) will develop a values based approach to recruiting onto NHS funded healthcare courses and HEE will work with NHS Employers on developing aptitude tests which can have a wider application. Starting with pilots, every student who seeks NHS funding for nursing degrees will first serve up to a year as a health care assistant (HCA). The scheme will be piloted and evaluated and neutral in terms of costs.
  • Revalidation for nurses: for an interim period it has been proposed that strengthening appraisal should be undertaken as opposed to revalidation for nurses but there is a commitment for the NMC to work with the lead nurses within the DH and Commissioning Board on an effective and affordable approach to revalidation.
  • Health and Care Support Workers: The Government has ruled out the regulation of Healthcare Assistants but has said that the Skills for Health and Skills for Care code of conduct and national minimum training standards should form the basis of the CQC's assessment of training standards for all staff. Employers can find information on our website about the referrals process within the Disclosure and Barring service on our website.  

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