The Government’s response to the Francis report
Parliamentary statement setting out the Government’s response to the Mid Staffordshire NHS Foundation Trust Public Inquiry.
With permission Mr Speaker, I would like to make a statement on the Government’s response to the Mid Staffordshire NHS Foundation Trust Public Inquiry.
I congratulate my Rt Hon Friend and predecessor for setting up the Public Inquiry, and for the many changes that he made foreseeing its likely recommendations.
I would also like to pay tribute to Robert Francis QC for his work in producing a seminal report that I believe will mark a turning point in the history of the NHS.
Many terrible things happened at Mid Staffs, in what has rightly been described as the NHS’s darkest hour. Both the current and former Prime Minister have apologised. But when people have suffered on this scale, and died unnecessarily, our greatest responsibility lies not in our words but in our actions.
Actions that must ensure the NHS is what every health professional and patient wants – a service that is true to the NHS values, that puts patients first, and treats people with dignity, respect and compassion.
The Government accepts the essence of the Inquiry’s recommendations and we will respond to them in full in due course. But given the urgency of the need for change, I am today announcing the key elements of our response so we can proceed to implementation as quickly as possible.
I have divided our response into 5 areas:
- Preventing problems arising by putting the needs of patients first;
- Detecting problems early;
- Taking action promptly;
- Ensuring robust accountability; and
Let me take each in turn.
- Preventing problems arising by putting the needs of patients first
To prevent problems arising in the first place, we need to embed a culture of zero harm and compassionate care throughout our NHS. A culture in which the needs of patients are central, whatever the pressures of a busy, modern health service.
As Robert Francis said,
The system as a whole failed in its most essential duty – to protect patients from unacceptable risks of harm and from unacceptable, and in some cases inhumane, treatment that should never be tolerated in any hospital.
At the heart of this problem, the current definitions of success for hospitals fail to prioritise the needs of patients. Too often the focus has been on compliance with regulation rather than on what those regulations aim to achieve. Furthermore, the way hospitals are inspected is fundamentally flawed, with the same generalist inspectors looking at slimming clinics, care homes and major teaching hospitals – sometimes in the same month.
So we will set up a new regulatory model under a strong, independent Chief Inspector of Hospitals, working for the CQC. Inspections 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.
The Nuffield Trust has reported on the feasibility of assessments and Ofsted-style ratings, and I am very grateful for their thorough work. I agree with their conclusion that there is a serious gap in the provision of clear, comprehensive and trusted information on the quality of care.
So in order to expose failure, recognise excellence and incentivise improvement, the Chief Inspector will produce a single aggregated rating for every NHS Trust. Because the patient experience will be central to the inspection, it will not be possible for hospitals to get a good inspection result without the highest standards of patient care.
However, the Nuffield rightly say that in organisations as large and complex as hospitals, a single rating on its own would be misleading. So the Chief Inspector will also assess hospital performance at speciality or 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.
We will also introduce a Chief Inspector of Social Care and look into the merits of a Chief Inspector of Primary Care in order to ensure that the same rigour is applied across the health and care system.
We must also build a culture of zero-harm throughout the NHS. This does not mean there will never be mistakes, just as a safety-first culture in the airline industry does not mean there are no plane crashes. But it does mean an attitude to harm which treats it as totally unacceptable and takes enormous trouble to learn from mistakes. We await the report on how to achieve this in the NHS from Professor Don Berwick.
Zero-harm means listening to and acting on complaints. So I will ask the Chief Inspector to assess hospital complaints procedures, drawing on the work being done by the Rt Hon Member for Cynon Valley and Professor Tricia Hart to look at best practice.
Given that one of the central complaints of nurses is that they are required to do too much paperwork and thus spend less time with patients, I have asked the NHS Confederation to review how we can reduce the bureaucratic burden on frontline staff and NHS providers by a third. I will also be requiring the new Health and Social Care Information Centre to use its statutory powers to eliminate duplication and reduce bureaucratic burdens.
2. Detecting problems quickly
Secondly, we must have a clear picture of what is happening within the NHS and social care system so that, where problems exist, they are detected more quickly.
As Francis recognised, the disjointed system of regulation and inspection smothered the NHS, collecting too much information but producing too little intelligence.
We will therefore introduce a new statutory duty of candour for providers, to ensure that honesty and transparency are the norm in every organisation. And the new Chief Inspector of Hospitals will be the nation’s whistleblower in chief.
To ensure there is no conflict in that role, the CQC will no longer be responsible for putting right any problems identified in hospitals: their enforcement powers will be delegated to Monitor and the Trust Development Authority, whom they will be able to ask to act when necessary.
We know that publishing survival results improves standards, as has been shown in heart surgery. So I am very pleased that we will be doing the same for a further 10 disciplines: cardiology, vascular, upper gastro intestinal, colorectal, orthopaedic, bariatric, urological, head and neck, and thyroid and endocrine surgery.
3. Dealing with problems quickly
The third part of our response is to ensure that any concerns are followed by swift action.
The problem with Mid Staffs was not that the problems were unknown; it was that nothing was done.
The Francis report sets out a timeline of around 50 warning signs between 2001 and 2009.
Ministers and managers in the wider system failed to act on these warnings. Some were not aware of them, others dodged responsibility. This must change.
No hospital will be rated as good or outstanding if fundamental standards are breached. And Trusts will be given a strictly limited period of time to rectify any such breaches. If they fail to do this, they will be put into a failure regime which could ultimately lead to special administration and the automatic suspension of the board.
4. Accountability for wrongdoers
The fourth part of our response concerns accountability for wrongdoers. It is important to say that what went wrong at Mid Staffs was not typical of our NHS, and that the vast majority of doctors and nurses give excellent care day-in day-out. We must make sure the system does not crush the innate sense of decency and compassion that drives people to give their lives to the NHS.
Francis said that primary responsibility for what went wrong at Mid Staffs lies with the board. So we will look at new legal sanctions at a corporate level for organisations who wilfully generate misleading information or withold information they are required to provide.
We will also consult on a barring scheme to prevent managers found guilty of gross misconduct finding a job in another part of the system. In addition, we intend to change the practices around severance payments, which have caused great public disquiet.
In addition, the General Medical Council, the Nursing and Midwifery Council and the other professional regulators have been asked to tighten their procedures for breaches of professional standards. I will wait to hear how they intend to do this, and for Don Berwick’s conclusions on zero harm, before deciding whether it is necessary to take further action.
The Chief Inspector will also ensure that hospitals are meeting their existing legal obligations to ensure that unsuitable healthcare support workers are barred.
5. Leadership and motivation of NHS staff
The final part of our response will be to ensure that NHS staff are properly led and motivated.
As Francis said,
All who work in the system, regardless of their qualifications or role, must recognise that they are part of a very large team who all have but one objective, the proper care and treatment of their patients.
Today I am announcing some important changes in training for nurses. I want NHS-funded student nurses to spend up to a year working on the frontline as support workers or healthcare assistants, as a prerequisite for receiving funding for their degree. This will ensure that people who become nurses have the right values and understand their role.
Healthcare support workers and adult social care workers will now have a Code of Conduct and minimum training standards, both of which are being published today.
I will also ask the Chief Inspector to ensure that hospitals are properly recruiting, training and supporting healthcare assistants, drawing on the recommendations being produced by Camilla Cavendish.
And the Department of Health will learn from the criticisms of its own role by becoming the first department where every civil servant will have real and extensive experience of the frontline.
Mr Speaker, 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.
But I want Mid Staffs not to be a byword for failure, but a catalyst for change.
To create an NHS where everyone can be confident of safe, high quality, compassionate care.
Where best practice becomes common practice.
And where the way a person is made to feel as a human being is every bit as important as the treatment they receive.
That must be our mission and I commend this statement to the House.