1. Responding to Francis DH Voluntary Sector Strategic Partner Programme 12 February 2012

2. Overview of today Background Francis in numbers Reprise of themes DH critique Patient and public involvement and scrutiny Nursing Common culture applied: the care of the elderly Group discussions Next steps

3. Introduction to Francis report Appalling and distressing stories at Mid-Staffordshire Hospital – patients not cleaned, not fed, treated roughly and without care or compassion An initial inquiry by Francis looked at the failings at Trust level, but a Public Inquiry was later called in 2010 which subsequently looked at the commissioning and supervisory failures across the system This was published on Wednesday 6 th February 2012.

4. Francis report – in numbers 3 volumes and an executive summary; 1782 pages 290 recommendations The recommendations have been grouped according to themes. The report allocates recommendations to organisations to take forward, with any remaining falling to DH to ensure they are taken forward. The report is structured around: –Warning signs that existed and could have revealed the issues earlier –Governance and culture –Roles of different organisations and agencies –Present and future

5. Francis report: reprise Culture change  An overall theme; important we don’t lose sight as we focus on the specific recommendations Fundamental standards  The standards themselves, and what Francis means  Criminal sanctions  The regulatory machinery: “a single regulator”, a new Chief Inspector of hospitals Openness, transparency and candour  Statutory duty of candour, backed up with criminal sanctions  Complaints and feedback as an engine of change  Transparency Leadership  New leadership college  Manager regulation/fit and proper person test Compassionate care  Nursing: entry, education and training, revalidation, RCN, “specialist older person’s nurse”  Healthcare assistants: minimum training, mandatory register  Professional regulators: NMC/GMC/HSE Information  Clear metrics on quality  Publication of data, inc in quality accounts

6. DH critique Francis:  Overall culture challenge as much for us as everyone else  DH remote from front-line  Too little clinical input in decision-making (culture as well as capacity)  Quality, safety and patient voice not sufficiently embedded in how we work  Looking to develop an initial response for end of next month with a fuller response later in the year Any initial thoughts on Francis?

7. Patient and public involvement and scrutiny (Chapter 6) Themes “There have been a wide range of routes through which patients and members of the public can link into health services and hold them to account, but these have been largely ineffective and have received little proper support or guidance.” “The mechanisms for patient and public involvement (Public and Patient Involvement Forums (PPIFs), Local Involvement Networks (LINks) had raised expectations about their role which proved impractical, relying on enthusiastic but uninformed and untrained volunteers and recruiting from a small, unrepresentative pool of the ‘usual suspects’.” “Patient involvement structures have relied on goodwill ad insight to make them work –in Stafford this meant they quickly broke down under dysfunctional relationships and in ‑ fighting, whilst the lack of support led to a preoccupation with constitutional arrangements rather than patient concerns. Recommendations There should be a consistent basic structure for Local Healthwatch throughout the country. The complexities of the health service are such that proper training must be available to the leadership of Local Healthwatch as well as, when the occasion arises, expert advice. MPs are advised to consider adopting some simple system for identifying trends in the complaints and information they received from constituents. They should also consider whether individual complaints imply concerns of wider significance than the impact on one individual patient.

8. Nursing (Chapter 23) Themes The aptitude and commitment of candidates for entry into nursing to provide compassionate basic hands-on care to patients should be tested by a minimum period of work experience by aptitude testing and by nationally consistent practical training. Effective support and professional development for nurses should be made the responsibility of professionally accountable responsible officers for nursing, and, in due course, reinforced by a system of revalidation The specialist skills, commitment and compassion needed for the nursing care of the elderly should be accorded the recognition they deserve by creation of a specialist registered status. Ward nurse managers and named nurses should be an intrinsic part of medical ward rounds and other contacts between doctors and patients. Recommendations Healthcare providers should be encouraged by incentives to develop and deploy reliable and transparent measures of the cultural health of front-line nursing workplaces and teams, which build on the experience and feedback of nursing staff using a robust methodology, such as the “cultural barometer”. Consideration should be given to the creation of a status of Registered Older Person’s Nurse. There should be a national code of conduct and common set of national standards for the education and training of healthcare support workers.

9. Common culture applied: the care of the elderly (Chapter 25) Themes There should be clear identification of responsibility for each patient’s care, led by a named consultant. There should be clear nursing responsibilities for each patient’s care and a clear dual responsibility at the point of handover. The experience of Stafford demonstrates the importance of constantly ensuring patients receive proper food and nutrition. Teamwork is vital and the contribution of all individuals in the team needs to be recognised There needs to be good communication with and about the patient, with appropriate sharing of information with relatives and supporters. The importance of the involvement of patient families and carers should be recognised by those caring for patients. Recommendations Hospitals should review whether to reinstate the practice of identifying a senior clinician who is in charge of a patient’s case, so that patients and their supporters are clear who is in overall charge of a patient’s care. There needs to be effective teamwork between all the different disciplines and services that together provide the collective care often required by an elderly patient; the contribution of cleaners, maintenance staff, and catering staff also needs to be recognised and valued.

10. Questions for small groups Group (1) - Patient and public involvement (a)How can we attract and recruit a more diverse group of volunteers, so that they provide a better cross-representation of the community? (b)How can we deliver better training for volunteers? Group (2) – Nursing (and care across all health professionals) (a)How can nurses best be supported to deliver the best they can in within such roles that are both physically and emotionally demanding? (b)How can we embed compassionate care across all health professionals including nurses? Group (3) - Common culture applied: the care of the elderly (a)What are the fundamental issues that need to be addressed when caring for the elderly? (b) How can good communication between family members and health professionals happen in a busy ward?

11. Next steps Initial Government response in March, followed by a fuller response in the summer Engagement to inform the response - bringing in the patient voice. National and local events, possible consultation needed on some elements to the response?

12. Contact us if you have further ideas or would like more information Mohini Morris, mohini.morris@dh.gsi.gov.uk Karen Noakes, karen.noakes@dh.gsi.gov.uk Public Inquiry Response Team