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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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    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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  • Juggling Dog

    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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  • Well said Susan. We do all know what's wrong, but we are powerless to do anything about it in the face of managers who don't care and have no compassion for us or the patients.

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  • Doesn't sound as if too much will change. It will just trigger further costly and lengthy enquiries with more money wasted to see how changes can be implemented, bickered about ad infinitum and then decided there isn't the money. Hopefully though it has made people sit up and realise that the basic care needs of patients must not be neglected.

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  • bad care is intolerable but instead of venting our anger at our colleagues lets as nurses unite together,stand up and be counted and let us dictate what's best for our patients., after all we are the ones that know, nothing will change if we don't .

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  • I agree with Rover Girl. Training is what Nurses and HCAs need - not Degrees or Masters qualifications. How will that ever teach you to look after a sick person with compassion and care. Yes we need education but not to the detriment of GOOD OLD NURSING CARE! and Yes, I was trained in a DGH with an onsite 'school of Nursing' and it sickens me to read about the lack of humanity out there. On a psoitive note - The Nurses (me included) for the most part do a fantastic job under very very testing circumstances.

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  • The comments made by Susan Markham (6-Feb-2013 5:29 pm) are mostly uninformed. This document is hugely important and has the impact to change the NHS for the good of all.

    Also, your ideas about Freemasonry are very outdated and wrong. Firstly, there are many women who are masons, in this country and around the world. Like their male counterparts, they spend a lot of their spare time raising lots of money for various charities which people are often not even aware of. Masons do not hide, but may be descrete regarding their membership due to how people like Susan judge them without having the slightest clue what they do. It has been a long time since Freemasonry might have been considered a way of assisting with career progression or getting away with things.

    Also, the view expressed by Rovergirl6 is also questionable. Back in the "good old days" it was the second year student nurses who taught the first years and the third years taught them plus ran the wards at weekends a lot of the time. Modern nurse education is designed to be a combination of education and traditional training and the latter is where front line nurses come into their own. Being a mentor holds a lot of responsibility to pass on that knowledge and experience and it is not just a process of assessment.

    I hope that there are a lot of changes that come about because of this report as they can only benefit our patients.

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  • What's more tragic than loss of lives? Nothing, please governments realise that to 'manage' a hospital is not the same as a factory, a shop or any other production service. People who hold responsibility for the budgets and planning need to understand the disastrous effects of gross negligence from the shocking cuts made.

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  • Many valid points have been raised here.
    What happened in Stafford is appalling, unfortunately I am sure that these will turn out not to be isolated cases. As nursing staff are expected to do more and more with less and less, something has to give.
    Managers are 'tick box' orientated, so long as the paperwork has been completed that is all they see. Ward mangers spend too much time off the wards at meetings leaving staff nurses running the wards as well as looking after their own patients, its all just too much.
    Despite us all working like Trojans, never getting off duty on time and everything else we all know that we have to contend with, where is the support when things do go wrong? Nowhere, we are on our own.

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  • 1. HCA regulation although welcome, will not address the incompetence + inefficiencies of the NMC of dealing with substandard nurses, dismissing inappropriate referrals or checking up on registrants portfolios. How would they cope when HCAs are registered. Probably put up fees to £150.

    2. RCN to split up its roles. This may improve patients care, or it may not. Professional recommendendations may not be listened to or implemented, eg safe staffing levels. Union, from the sounds of a lot of blogs, there aren't many RCN members left at the trust and even less that are willing to stick their head above the parapet by being reps there. In a trust, there maybe 15 recognized unions, of which possibly 3 or 4 relates to nursing/midwifery. Did the other unions give good support, what did they do well that the RCN didn't. Also did nurses, not in a union, need any support, or was it assumed all unions would support all nurses. Sounds like it was left to a few people to officially flag up concerns and acted as advocates for their patients.

    3. All NHS staff open+honest. In the 'good old days', we'd not dare to speak out of place, the hierarchies would close ranks, we might use egg white, milk + gamgee to treat pressure ulcers, etc. This should happen now, as well as managers + directors being honest when their policies lead to mistakes + poor care.

    4. CQC might be able to improve standards, through unannounced visits at any time of day or night, as care is 24/7. To focus on holistic + contributory factors to deliver good care.

    5. A fit Directors test would be great. Is that an annual or biannual test. There are recognised management professional bodies + full management courses (not just a couple leadership study days), to improve managers training + development. Other professions have to be highly trained, so should managers. Should have gone further with regulation of all managers. Shame politicians can't sort their own house into order first. Poor strategic policies + targets ultimately lead to implementation of poor care + support of those who need it.

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  • Yep, ward managers and management need to be seen on the wards, should periodically work full clinical shifts not delegating it out or vanishing off to do audits + other paperwork, patients care to come first.
    Support should come from more senior + experienced staff, regardless of grade. This should be readily accessible if you required help + support, not waiting until the morning when the manager comes in. But due to being short staffed, they're snowed under helping + working too. Then contact site manager + file an incident report due to being unsupported + patients were potentially unsafe.

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  • it was fairly obvious from the outset when they first started cutting jobs what the impact on patient care would be.

    I remember finding that my colleagues and I were suddenly doing the work of two nurses, and then on some shifts, two to three, until the situation became intolerable. When we pointed this out to our bosses and tried to discuss it with them the response was it was up to us to organise our work better and prioritise!

    We were a general medical ward with a fair share of acute cases some of whom should have been in ICU but were restricted because of lack of space or their age. This meant we had emergencies and patients whose condition could suddenly and rapidly deteriorate requiring all our attention. We often had unplanned admissions announced by A&E at short notice usually when they were already on the way up to the ward.

    Our bosses were very good at doing the rounds and spotting what we hadn't got round to doing and our omissions because we had been too busy. This used to upset me until I realised I could also walk onto any ward and make the same observations if I had been so inclined. Instead, where I could leave my ward for a few minutes in the hands of my colleagues I would just lend a hand. I also realised for some reason it is easier to note what has not been done or where short cuts might have been taken than it is to see what has been achieved like giving good care and making a patient comfortable.

    I also remember wondering to myself which was worse, to carry on working under these conditions and trying to make the most of the situation in the hopes things would improve, or being without a job at all like many other nurses and with poor prospects for finding another late in one's career.

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