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Top five Francis report policy recommendations that will affect you as a nurse


Following the publication in February of the Francis report, Nursing Times rounded up the top five policy recommendations from the report that will affect you as a nurse

  1. HCA regulation proposed - Healthcare support workers should be subject to regulation by the Nursing and Midwifery Council in one of 290 recommendations from the Mid Staffordshire Foundation Trust public inquiry.
  2. RCN should consider seperating its role as a trade union and professional organisation. Robert Francis QC has described the Royal College of Nursing as “ineffective”.
  3. All NHS staff should be open and honest when mistakes happen. The Mid Staffordshire Foundation Trust public inquiry report has recommended there should be a series of new laws requiring all NHS staff and directors to be open and honest when mistakes happen.
  4. The Care Quality Commission should not just deal with quality. It should take on responsibility for “corporate governance” and “financial competence” aswell, Robert Francis QC has recommended.
  5. NHS Directors to be subject to ‘fit and proper person test’. Directors of NHS providers should be subject to a new fit and proper person test, Robert Francis QC has recommended. However, he has not called for regulation of all NHS managers.



Readers' comments (26)

  • Re regulation for all NHS managers - I would have hoped that lessons were learned from the Winterbourne Inquiry regarding accountability of managers.
    Change and accountability has to be made at the top too!

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  • Susan Markham

    £13 million? Dear Lord, Robert Francis could have just have come around to my house and I would have told him all that stuff for free. I would even have made him a cup of tea with a jammy dodger thrown in!

    Honestly, what a waste of time, money and lives... we all know how this is going to go down... Joe Public will be told that Nurses are to blame for all of the failings of the NHS.

    The “not so” subtle nuances of the report will, gradually, be swept under the carpet because a) The government doesn't want to hear it b) Joe Public doesn't understand it and c) The Daily Mail doesn't understand it, doesn't want to hear it and merely wants to peddle “doom and gloom” stories because that's what its readers love to revel in... unlike The Sun readers who just want bums and tits!

    A good effort Mr Robert Francis but, alas, that's £13 million down the drain that could have been spent on hiring a few more nurses in the meantime!

    To make it effective you should have made it mandatory that NHS managers were professionally regulated (like nurses, doctors, accountants, architects and even humble plumbers) but of course most male NHS managers are Free Masons so you couldn't pull that trick – because you would have to admit that you are a Free Mason too. Regulation might demand disclosure – and that's something that goes against Masonic policy.

    Never mind sir... it was a good (but expensive) exercise – you made a few bucks out of it. I am sure that in another 20-30 years they will repeat the exercise with a similar zero effect. The RCN will still be there – snobby as ever... the NHS managers will still be unregulated onanists... there will still be HCA “wannabe” nurses... patients will still be be secondary to “cost-cutting” measures... and hospital “inspections” will still be done via the “old-boy” networking system.

    The only thing I can take any comfort from is the fact in 20 years I will be dead... therefore I will not have to say “I TOLD YOU SO!”

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  • well said Susan Markham. The only thing I disagree with you is I wouldnt give him a jammy dodger. What a waste of money.

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  • You are not seeing the big picture if you think the Francis Report is a waste of time. Healthcare in the UK is getting a wake up call and not a moment too soon! You perhaps knew some of the conclusions already. Truth be known we all did BUT we need to focus on the future constructively and Judge Francis can help us. He spelled it out in BIG letters. We need to respond through BIG changes.....all of us need to be movers and shakers. The time for talk has run out.

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  • Carol Cleeton | 6-Feb-2013 11:21 pm

    well said, Carol Cleeton.

    "The time for talk has run out." the time for some of the vacuous comments we see on this site too!

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  • Susan Markham, well said.

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  • yes Susan Markham I too agree with you.

    All we need is more staff, GOOD management and inspectors doing their job without fear or favor.
    Also regulate the whole lot from managers to carers.

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  • Sandra Joyce Powell

    We need trained nurses on the ward on every shift all the time not just to do drugs and treatments to be there training HCA staff., observing patients.

    I believe we need to go back to nurse training in our hospitals in nursing schools attached not in universities ..We need training not education .there is a vast difference. and student nurses should be paid a living wage. not a bursary.

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  • I have spoken out about poor practice and dangerous staffing levels at the Trust I work at on numerous occasions. Where did it get me? Disciplined. I imagine those nurses and doctors at Staffordshire did exactly the same. What worries me is the media's love of running the nursing profession into the ground and the public's love of hearing these stories. I think there should be a media block on such stories unless there is 100% proof of their authenticity, which often there is not.

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  • jane jenkins

    The Francis report is hugely important !

    Awful things happened at Mid Staffs, and on the wards those things were hidden in plain sight: there were nurses and doctors at Mid Staffs. There were senior managers, at Mid Staffs.

    The hospital itself, was also hidden in plain sight: it isn’t as if it was ‘a stealth hospital’ and it couldn’t be seen by the regulatory bodies.

    Did these professionals, bring the scandal to light ? According to a report of Francis I’ve been reading in the press –

    The truth was finally uncovered partly because of the high mortality rates at the hospital, which were 27 to 45 per cent above what they should have been, but "mainly because of the persistent complaints made by a very determined group of patients and those close to them".

    The ‘professionals’ pretty much all get laid into –

    Robert Francis QC's 1,782-page report into the "disaster" catalogued failures at every level, from nursing staff through layers of management and watchdog bodies up to the Department of Health. Between 2005 and 2009, up to 1,200 patients died unnecessarily and many more were "failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety".

    Nurses and doctors who attempted to raise concerns were silenced by managers who were interested in figures, not patient care; regulators didn’t look hard enough; laymen who complained were given the brush off (well, they aren’t ‘professionals’, are they, so obviously they can’t know what they are talking about !), etc.

    Even before the report came out, in anticipation we have seen the slow roll-out of the Family and Friends test, and nurses and doctors have been told loudly that they are professionally obliged to raise concerns about patient safety (a duty they had at the time – but clearly did not act on).

    It is far too easy, in a huge hierarchical structure/system, for everyone to just concentrate on ‘my bit’ in isolation of the overall objective: in this case, the objective is supposed to be GOOD PATIENT CARE ! This report makes it obvious, that left to their own devices, professionals often drift away from that objective – the only way to prevent that, is a stronger patient voice, and openness and transparency about concerns, etc.

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