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Francis response: Government accepts all but nine recommendations

The government has at least partially accepted all but nine of Robert Francis QC’s 290 recommendations to improve care in the NHS, it has announced.

Health secretary Jeremy Hunt unveiled the much anticipated response to the report into care failings at Mid Staffordshire Foundation Trust this lunchtime.

Although it only formally rejected nine of the recommendations made by the Francis report, neither did it clearly accept the remaining 281.

For example, 57 recommendations were accepted “in principle” and 20 “in part”, meaning the recommendation has been accepted with some differences or new ideas relating to how it will be delivered.

Three of the rejected recommendations relate to the regulation of healthcare assistants.

The government has also decided against adopting in full Francis’s recommendations in relation to a statutory duty of candour and making it a criminal offence to obstruct healthcare professionals from exercising a duty of candour.

However, the government plans to address both of these issues by strengthening professional codes of conduct.

Mr Hunt said Mr Francis’ report and the actions that will follow it would be “completely transformational in terms of its impact on the NHS”.

“There’s a real sense of the culture of the NHS beginning to change,” he added.

Mr Hunt also highlighted the new requirement for trusts to publish staffing levels on their wards.

He said the government recognised it was not possible to deliver good care without safe staffing levels and had looked carefully at the evidence for delivering a minimum staffing levels from the centre but had decided the numbers were different for different wards.

Mr Hunt also said Mr Francis’ report and the actions that will follow it would be “completely transformational in terms of its impact on the NHS”.

“There’s a real sense of the culture of the NHS beginning to change,” he added.

Mr Hunt also highlighted the new requirement for trusts to publish staffing levels on their wards.

He said the government recognised it was not possible to deliver good care without safe staffing levels and had looked carefully at the evidence for delivering a minimum staffing levels from the centre but had decided the numbers were different for different wards.

The government’s reponse says NHS England will begin to publish “never events” data quarterly before the end of 2013, and will “re-launch the patient safety alerts system by the end of 2013 in a clearer framework”, working the CQC to monitor its use.

The national commissioner will also create a “Patient Safety Collaborative Programme” to “spread best practice, build skills and capabilities in patient safety and improvement science, and to focus on actions that can make the biggest difference to patients”.

It will establish a Patient Safety Improvement Fellowship scheme to develop 5,000 “fellows” within five years.

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Readers' comments (8)

  • We all recognise that different specialities, different bed numbers, ward layouts, level of complexity and dependency impact on the staffing numbers and skill mix on a ward - how then can publishing data out of this context be meaningful?

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  • I do think it would be helpful to have minimum staffing levels. There is too much wriggle room and "soft" expressions like guidelines. Too much room for yet another meeting and talking shop. There need to be directives and measurable targets so "failure" can be identified and action taken. The minimum staffing level should be 1 nurse per X patients (maybe 6 or 7). With a degree of difficulty and need for a variety of competencies there will usually be a need for more staff, and an appropriate skill mix, but NEVER less. There needs to be some clear mark between qualified and unqualified staff as well. At least make a start.

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  • Having read through all the points made in the government response to the Francis Report, I am sorry to say that I am completely underwhelmed. There are quite a few cosmetic, headline-seeking proposals to apease the public, but absolutely nothing of any substance to address the underlying issues of lack of staff, lack of protection for staff (quite the opposite, in fact), lack of resources and no new plans or mechanisms being put in place to solve ....well, anything. There is nothing which will prevent another occurrence of Stafford Hospital proportions. A wasted opportunity.

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  • No regulation of HCA's - Hunt does not want difficulties in de-professionalising the nurse workforce so they can get 'nurses' for half the pay of qualified staff.

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  • Aaron Rudd

    For a £13,684,100 report, I expected alot better value for the taxpayer in the government response.

    This is why politicians shouldn't make theses decisions. They should decide budgets, a NHS council of HCPs, patient advocates and supporting civil servants should decide how it is spent.

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  • Aaron Rudd

    "Patient Safety Collaborative Programme"

    Is it just me or does this sound suspiciously like the NPSA that was decimated in the useless rebranding exercise of 2012?

    2014 will be another brave new year of trying to do our best despite our government instead of being supported by it.

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  • This government response is only relevant to NHS England. What do nurses working in the other UK nations think about this? I understand that Mid Staffs happened on NHS England's 'watch', but I would be interested to know how this is being received elsewhere. Even those in Oz. Europe, US, etc. The NHS is no longer 'national' in terms of the UK, but there are nurses from all over who regularly comment in the NT.

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  • Minimum staffing levels could be hard to set, especially where the ward needs 1-to-1 or 1-to-2 staff/patient care, as in an ICU/HDU. However, on general wards, I feel it is vital for staff morale and stress levels, but also patient and staff safety to have a realistic staff/patient ratio. I agree with the views that 1 band 5 per 6-7 patients is ideal, but will it ever happen? I really hope it does, and soon!

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