The quality of patient care will be put at the heart of the NHS in an overhaul of the health and care system in response to the Francis Inquiry. Health Secretary Jeremy Hunt announced today how a culture of compassion will be a key marker of success, spelling an end to the distorting impact of targets and box ticking which led to the failings at Stafford Hospital.
Hospitals and care homes will be encouraged to strive to be the best, the basic values of dignity and respect will be central to care training and, if things go wrong, patients and their families will be told about it.
Radical new measures will be introduced to achieve this including Ofsted-style ratings for hospitals and care homes, a statutory duty of candour for organisations which provide care and are registered with the Care Quality Commission, and a pilot programme which will see nurses working for up to a year as a healthcare assistant as a prerequisite for receiving funding for their degree.
The response is accompanied by a statement of common purpose signed by the chairs of key organisations across the health and care system. It renews and reaffirms the commitment to the values of the NHS, as set out in its Constitution, and includes pledges to work together for patients, always treat patients and their families with compassion, dignity and respect, to listen to patients and to act on feedback.
Jeremy Hunt said:
The events at Stafford Hospital were a betrayal of the worst kind. A betrayal of the patients, of the families, and of the vast majority of NHS staff who do everything in their power to give their patients the high quality, compassionate care they deserve.
The health and care system must change. We cannot merely tinker around the edges – we need a radical overhaul with high quality care and compassion at its heart. Today I am setting out an initial response to Robert Francis’ recommendations. But this is just the start of a fundamental change to the system.
I can pledge that every patient will be treated in a hospital judged on the quality of its care and the experience of its patients. They will be cared for in a place with a culture of zero harm, by highly trained staff with the right values and skills. And if something should go wrong, then those mistakes will be admitted, the patient told about them and steps taken to rectify them with proper accountability.
I and the chairs of key organisations involved in care have pledged to do this and make our health and care system the best and safest in the world.
The Government’s response to the Francis report includes plans to:
Put in place a culture of zero-harm and compassionate care
- there will be a new regulatory model under a strong, independent Chief Inspector of Hospitals
- the Chief Inspector will introduce single aggregated ratings. The Nuffield Trust rightly said that in organisations as large and complex as hospitals a single rating on its own could be misleading. The Chief Inspector will also develop ratings of hospital performance at department level. This will mean that cancer patients will be told of the quality of cancer services, and prospective mothers the quality of maternity services
- the Chief Inspector of Hospitals will assess hospital complaints procedures
- the CQC will move to a new specialist model based on rigorous and challenging peer-review. Assessments will include judgements about hospitals’ overall performance including whether patients are listened to and treated with dignity and respect, the safety of services, responsiveness, clinical standards and governance
- a new Chief Inspector of Social Care will ensure the same rigour is applied across the health and care system. The merits of having a Chief Inspector of Primary Care are also being explored
- the NHS Confederation will review how we can reduce the bureaucratic burden on frontline staff and NHS providers by a third
Detect problems quickly
- a new statutory duty of candour will ensure honesty and transparency are the norm in every organisation overseen by the CQC
- the new Chief Inspector of Hospitals will be the nation’s whistleblower- in-chief
- publishing survival results improves standards, as has been shown in heart surgery. Survival rates for a further 10 disciplines, including cardiology, vascular and orthopaedic surgery will now be published
Deal with problems quickly
* a new set of fundamental standards will be introduced to make explicit the basic rights that anyone should expect of the NHS. They will be produced by the Chief Inspector of Hospitals, working with NICE, patients and the public
* where these standards are breached, a new failure regime will ensure that firm action is taken swiftly. If it is not, the failure regime could lead to special administration with the automatic suspension of the Board
Accountability for wrongdoers
- health and social care professionals will be held more accountable
- we will consider the introduction of legal sanctions at a corporate level for providers who knowingly generate misleading information or withhold information from patients or relatives
- the General Medical Council, the Nursing and Midwifery Council and the other professional regulators have been asked to tighten and speed up their procedures for breaches of professional standards
- the Chief Inspector of Hospitals will also ensure that hospitals are meeting their existing legal obligations to ensure that unsuitable healthcare assistants are barred
Leadership and motivation of NHS and social care staff
- NHS-funded student nurses will spend up to a year working on the frontline as healthcare assistants, as a prerequisite for receiving funding for their degree. This will ensure the people who become nurses have the right values and understand their role
- nurses’ skills will then be revalidated, as doctors’ are now, to ensure their skills remain up to date and fit for purpose
- healthcare support workers and adult social care workers will now have a code of conduct and minimum training standards, both of which are published today: www.skillsforhealth.org.uk/codeofconductandtrainingstandards
- the Chief Inspector will ensure that hospitals are properly recruiting, training and supporting healthcare assistants, drawing on the recommendations being produced by Camilla Cavendish
- the Department of Health will become the first department where every civil servant will gain real and extensive experience of the frontline
The Government is also today publishing a revised NHS Constitution following a recent public consultation. It incorporates many of the changes that were consulted on and, where possible, further changes resulting from additional suggestions heard through consultation. A copy can be found on the Department of Health website
It is likely there will be a further consultation later in the year on further changes to the NHS Constitution, with the aim of incorporating further recommendations made by Robert Francis QC.
Notes to editors
For further information, media should contact the Department of Health Media Centre on 020 7210 5738 / 5707 / 5282 / 5896 / 5947.
The public can contact public enquiries on 020 7210 4850.