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Editor’s comment

'Are the Francis recommendations comprehensive?'

Robert Francis QC has been thorough in gathering his evidence at the Mid Staffordshire Foundation Trust public inquiry, but are his recommendations as comprehensive?

They provide detail, and there are lots in the report’s recommendations that nurses can be pleased with.

Revalidation of nurses – along the lines that the General Medical Council is starting to do for doctors – could rekindle a sense of professional pride and status to those who feel they have lost it.

Much of the report talks about the importance of strengthening nursing’s voice, and we certainly can’t argue with that as a laudable aim.

Mr Francis suggests a four-pronged attack to achieve this. He wants to build the public profile of the Nursing and Midwifery Council – something that will probably be difficult to do without a registrant in either the chief executive or chair’s role.

He also recommends the appointment of a “responsible officer for nursing” in each trust, who would report to both the Department of Health and the NMC.

Another thing he suggests for consideration is splitting up the Royal College of Nursing into a trade union and a professional college that upholds standards.

Finally, he questions whether the chief nursing officer role in England – newly repositioned with the NHS Commissioning Board – should be reviewed to ensure that nursing has a strong enough professional lead and equal authority as the chief medical officer.

But while virtually every nurse will support the ambition to give the profession a stronger voice, there are other more complex recommendations that may not make it through to legislation.

Up first in that category is the regulation of healthcare assistants. While this could make the biggest difference to public protection, it looks likely the government won’t act on that recommendation. The prime minister sounds enthusiastic about ensuring national training standards for HCAs but he describes registration of his group as “potentially bureaucratic”.

Little wonder – at nearly 800,000 they’re a much larger group of staff to regulate, and with the NMC struggling to manage its own register of nurses effectively, it would seem counter-intuitive to add such a huge amount of work to that burden.

Mr Francis believes it can be done cost-effectively by passing on the cost to HCAs, although I doubt that workforce would be universally happy to absorb this additional charge to work.

The report does suggest minimum safe staffing levels should be drawn up by the National Institute for Health and Clinical Excellence and policed by the Care Quality Commission. However, many in the profession, including The Florence Nightingale Foundation and Queen’s Nursing Institute, have said this doesn’t go far enough to ensure that the right number and skill mix of nursing staff will be available to carry out safe care.

For some, it doesn’t go far enough because it doesn’t mandate minimum staffing numbers.

So over to you. What do you think? What do you like in the Francis report and what do you think is unworkable?

Readers' comments (3)

  • The question isn't whether his recommendations go far enough- there are actually far too many of them so each gets lost in the mire and the Government can cherry pick from them without appearing to do nothing.

    We should choose 5 of his recommendations for nursing and start a political campaign to ensure the Government implements them.

    The requirement that all providers are held to account (remember he says it should be a criminal offence to not comply with a fundamental standard) for using NICE minimum nurse staffing tool is the best chance we are going to get to improve staffing.

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  • Jenni
    Is it because your remit is to write about Nursing that you have concentrated your comments upon that profession or is it because the report says nothing about the other 'professions' who inhabit hospitals and work directly with patients? Physio, O.T.s , ward pharmacists and, of course, doctors of every level?

    Are nurses being scapegoated (again) or should every professional person who worked at Staffs be looking to their laurels?

    I am worried that we are not being given the picture in context - is my profession really entirely to blame for what happend at that most unfortunate place?



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  • Maria Gough
    Indeed, what happened to the 40 medics reported to the GMC over Staffs? Nothing. It was all down to the nurses, apparently, which is why the papers have brushed over this, and also the fact that the organisation was 13% low on its nursing numbers. Nurses fault again for not doing 13% more work.

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