The hard work begins: The Government's initial response to the Francis Report

The Government has issued its initial response to the Francis Report of the Mid-Staffordshire NHS Foundation Trust Public Inquiry.  It sets out a five point plan intended to herald an end to failure and a call for excellence. In summary, the plan covers the following:

A. Preventing problems

• A revised Constitution will reinforce the concept of working together for patients. This will be underpinned by greater scrutiny in the shape and make-up of Trust Boards; there will be greater emphasis on radical transparency, excellence in leadership and clarity of accountability.
• Unnecessary bureaucracy will be cut by one third
• Information collection will become more focussed and the Health and Social Care Information Centre will be tasked reducing the information burden year on year.

B. Detecting problems quickly

• A new Chief Inspector of Hospitals and a Chief Inspector of Social Care will be appointed, supported by expert inspectors
• CQC will be given a power to conduct ratings of hospitals and care homes, which will indicate that they are "outstanding", "good", "requiring improvement" or "poor".
• Information on outcomes will be made more transparent
• Legal sanctions for massaging performance figures may be introduced
• The contractual duty of candour will be reinforced through a statutory duty on boards
• The complaints process will be reviewed

C. Taking action promptly

• The fundamental standards proposed by Francis will be drawn up by CQC
• There will be a 3-stage process for dealing with failure: Firstly, local resolution between Board and Commissioners; secondly, deployment of Monitor or the Trust Development Authority (TDA); thirdly, initiation by the Chief Inspector of a failure regime, comprising suspension of the Board or putting the hospital into administration.
• A single set of expectations on hospital will be produced; the data and methodology is to be agreed between CQC, NHSCB, Monitor and TDA.

D. Ensuring robust accountability

• Where the Chief Inspector identifies criminally negligent practice he will refer the matter to the Health and Safety Executive for prosecution
• The legislative framework governing the GMC and NMC will be overhauled
• Failing NHS Managers will be put on a national barring list

E. Ensuring staff are trained and motivated

• Nurses seeking NHS funding for degrees will have to serve one year as healthcare assistants
• Nurses will be subject to revalidation
• There will be a code of conduct and training for all care assistants
• Unsuitable healthcare assistants will be barred from patient care
• The NHS Leadership Academy will seek out leaders from outside the NHS
• An elite fast track programme will be developed for top NHS positions
• Department of Health civil servants will be required to gain meaningful frontline experience

The Government’s response draws extensively on existing initiatives, both statutory and non-statutory, many of which were in place before the Francis report was published, but the Francis report has provided impetus and focus to otherwise fragmented reforms.

Patient associations have given the new proposals mixed reports.  They accept it moves patient safety forwards but perhaps not far enough.  A co-ordinated statement on improving the quality of staff was welcomed by the Royal College of Nursing after Jeremy Hunt announced that reviews by the Chief Inspector of Hospitals are likely to lead to increased nurses on wards. The main things missing relate to criminal accountability for individuals, but we may yet see some of this this introduced following a review by Don Berwick.  The GMC and NMC are reviewing their models of professional regulation against the additional backdrop of a Law Commission review of professional regulation.

Although it has been given little press coverage, it will be of immediate and medium term interest is the renewed call for NHS Trusts to set out how they intend to respond to the Inquiry’s conclusions by the end of the year, and then report on progress each year subsequently.

It is important to note that this has been titled the Government's 'initial' response, indicating there will be a further response or responses in due course following much professional and public consultation.  For an 'initial' response, there is plenty here to indicate real changes.