An increased focus on patient safety and staffing since the Francis inquiry into the care scandal at Mid Staffordshire NHS Foundation Trust has led to directors of nursing in health service hospitals having more of an influence on fellow executive staff, a report has suggested.
However, improvements brought in since the inquiry are now being partly “halted”, said the report, which was based on a review of the changes to the way acute hospitals in England were being led since the inquiry’s findings were released in 2013.
“The strengthened focus on safe staffing may have provided a platform for the board nurse to have a stronger voice”
Report on Francis impact
This is due to staff shortages and a reliance on expensive agency workers “known to be likely to compromise continuity and safety of care”, said the report, which was published yesterday by the universities of Manchester and Birmingham, and the Nuffield Trust think-tank.
The report, commissioned by the Department of Health, was based on work that included interviews with national figures, a survey of 90% of NHS board members at acute and specialist hospitals, and discussions with patients, staff and board representatives at six hospital trusts in 2016.
“We found in this study (something we had not particularly sought), that the strengthened focus and priority in the post-Francis era on safe staffing, patient experience, and patient safety may have provided a platform for the board nurse to have a stronger voice and influence on the board,” said the report.
One chief nurse described her role as being to “to prick the conscience of the board”, noted the report – called Responses to Francis: changes in board leadership and governance in acute hospitals in England since 2013.
“There is a sense of Francis report-related progress being halted to some extent as a result of a wider context of staff shortages”
Report on Francis impact
A close working relationship between the chief nurse and medical director was likely to lead to the hospital board paying attention to improvements to patient safety and clinical issues, it added.
The majority of board members that took part in the survey said patient safety was their biggest challenge and many said the Francis inquiry had prompted them to ensure this was their core focus, according to the report.
“Francis was seen, in some instances, to be an enabler to boards making improvements, by focussing board aims, and acting as a reminder to place quality of care and patient safety at the top of the agenda. However, financial pressures were still seen as a barrier to making these ambitions a reality,” it said.
The lack of a phased introduction of setting safe staffing levels meant all NHS trusts were trying to recruit from the same pool of agency, highlighted many survey respondents.
“Some felt this was part of a wider problem with Francis in that it had created far too many recommendations that led to additional bureaucracy and higher costs,” stated the report.
It concluded that the “most significant impact” of the Francis report had been an increase in nurse staffing levels – and that boards had concluded quality and safety of care was more important than financial performance.
“There is still more to be done to ensure patient care and safety can remain at the top of board agendas”
But it stressed there was now increasing pressure on hospital boards due to there being a “very scarce” workforce at the same time as no additional funding, leading to rising deficits.
“This runs directly counter to the post-Francis requirement to invest in higher levels of nurse and other staffing (for example medical staff in accident and emergency departments) as a way of ensuring a properly patient-focused culture of compassion and fundamental standards of care,” said the report.
“Thus, there is a sense of Francis report-related progress being halted to some extent – not as a deliberate act, but as a result of a wider context of shortages in the supply of staff, and a resulting reliance on costly agency staff known to be likely to compromise continuity and safety of care,” it warned.
Naomi Chambers, professor of health management at the University of Manchester, who led the study, said: “From our research over the past two years, it is clear that NHS hospitals across the country have taken measures to organise better care for patients.
“This is in part due to the more focused and visible approach on the part of boards, but an increasingly challenging policy context is making further improvements more difficult to implement,” she said.
Judith Smith, professor of health policy at the University of Birmingham, added: “This report has shown that there is still more to be done to ensure patient care and safety can remain at the top of board agendas in what are very difficult financial and operational times for the NHS.”