APPENDIX 4
Government response to Francis report – specific areas for Trust action
Response
Trust position and action
A named hospital consultant and nurse responsible for care to
be listed at each patient’s hospital bed; and a named
accountable clinician for people receiving out-of-hospital care,
starting with vulnerable older people.
This will be taken forward as part of our developing strategy for
older people.
By April 2015 everyone with a long-term condition will be
offered a personalised care plan. People who are already
receiving NHS Continuing Care will have a ‘right to ask’ for a
personal health budget (including direct payments) from April
2014 and a ‘right to have’ one from October 2014.
The Trust is working with commissioners on pathways for patients
with long term conditions.
Statutory duty of candour: the Government will consult on
whether, where a trust has not been open with patients or their
families about a patient safety incident, the NHS Litigation
Authority could have the discretion to reduce or remove that
Trust’s indemnity cover for that claim, and whether trusts could
be required to reimburse the NHS Litigation Authority for a
proportion or all of the payment.
The Trust has a system in place for reporting of serious untoward
incidents, however, it does rely on individuals recognising and
reporting these. Although we are increasing our levels of
reporting, there is concern about delays in some incidents being
recognised as such and being reported action is ….???
The professional duty of candour on individuals will be
strengthened through changes to professional guidance and
codes, to include consistent approaches to candour and
The Trust is part of a “Long term Conditions Collaborative” with
TEWV, Darlington Borough Council and Darlington CCG, and
following an initial six month scoping exercise, a report has been
published which will be reviewed by partners around how to take
the collaborative forward in 2014/15.
prompt reporting of errors (including near misses). This is to
include a common responsibility to be candid with patients
when mistakes occur whether serious or not, and clear
guidance that professionals who seek to obstruct others in
raising concerns or being candid would be in breach of their
professional responsibilities.
Trusts will be expected to provide clear complaints guidance to
patients, families and carers, with trust boards to take personal
responsibility for responding to complaints. Complaints data
and lessons learned will be published quarterly. CQC will
review complaints responses in its inspections, and NHS
England will explore complaint resolution levels to enable
comparison across hospitals.
Complaints policy and guidance is published online, and
information is available within patient care areas.
The National Quality Board and Chief Nursing Officer are
publishing guidance on current evidence on safe staffing to
clarify expectations on NHS bodies. By summer 2014, NICE
will issue evidence-based guidance on safe staffing levels in
acute care settings, and thereafter for staffing in non-acute
settings, including mental health, community and learning
disability services.
The Director of Nursing is looking at how information about
individual ward performance can be displayed clearly for patients
and visitors to see. This will include ward staffing levels.
From April 2014, and June 2014 at the latest, NHS trusts will
publish ward-level information on whether they are meeting
staffing requirements, with nursing and midwifery staffing
published monthly. A six month intervals, trusts will be required
to review levels and evidence their conclusions. The data will
form the basis for commissioner-provider discussion.
The Chief Inspector of Hospitals will monitor trusts’
performance on staffing levels and take action where there is a
Complaints are reported to the Board as part of the CLIPs report,
and complaints responses are reviewed and signed by the Chief
Executive or a Director.
There are issues around measuring appropriate levels of nurse
staffing, based on the changing acuity of patients on a ward and
skill mix, and other issues such as the layout of a ward including
numbers of single rooms.
risk of patient harm. Appropriate staffing levels will be included
as a core element of the CQC’s registration regime.
CQC inspections will look more closely at records, with visits
taking place at night and at weekends, with more
unannounced inspections.
Patient records was a focus of the recent visit to UHND, and
action is required in this area.
This is being taken forward through ….?
ECDM will improve the accessibility of records and is a move
towards electronic records.
CQC will examine whether a culture of transparency is being
promoted, and staff can whistleblow through professional
regulatory bodies. All compromise agreements must include a
clause making clear that the agreement does not prevent
disclosure under the Public Interest Disclosure Act 1998. NHS
England is developing a friends and family test for NHS staff
and piloting a ‘cultural barometer’.
The Trust has a clear whistleblowing policy.
Monitor will publish an updated Code of Governance for FTs in
early 2014 which will make recommendations to strengthen
corporate governance in light of the Inquiry report. There are
also plans for regular governance reviews of FTs which will
include quality governance.
The updated code of governance is awaited.
Well-treated staff treat patients well. Guidance to support good
staff engagement will be developed, and Health Education
England will lead the focus on training, CPD and appraisal
improvements to support a compassionate culture.
The Trust moved away from the NHS appraisal framework
towards one based on values and behaviours.
Improving the quality of nursing and the support available to
We have no details as yet of the “friends and family test” for staff
and how this would be administered. The Trust’s score in the
2012 staff survey showed a slight improvement in the score for
staff recommendation of the Trust as a place to work and receive
treatment.
Two focus groups are being held to review the current appraisal
framework this month and next month.
nurses is at the heart of the response to the Francis report.
The Government will continue to implement Compassion in
Practice and the 6Cs, fostering nurse leadership and
supporting the implementation of nurse revalidation. How older
people are treated is seen as the key test of whether there is
safe, compassionate care. A bespoke older persons’ nurse
post-graduate qualification training programme will be
developed. Pre-degree care experience for nurses is also
being explored.
Following the Cavendish review, the Government has asked
HEE to lead development of a new Care Certificate to ensure
that Healthcare Assistants and Social Care Support Workers
have the right fundamental training and skills in order to give
personal care to patients and service users.
The Government urges trusts to continue holding listening
events to understand the concerns of their patients and staff
and identify areas for improvement. Across the health and care
system, staff want to deliver safe, effective and compassionate
care, to feel safe to raise any concerns, and to have
confidence that these will be tackled.
Prepared by Edmund Lovell
9 December 2013
The Trust is continuing to pursue recruitment of additional nursing
staff so that it can achieve “supervisory ward sisters” on all wards
and in community teams, but this remains challenging on the
supply side.
The Trust is also developing its approach to care of older people,
which has been identified as a key part of our clinical strategy,
and a consultant Head of Service has been recruited who will, join
the Trust in the New Year.
Following our listening events in May, we held Great All Round
events in Autumn 2013.
“Breakfast with Sue” events have begun with the chief executive
Further events are planned in 2014, with a focus on clinical
strategy.