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Francis response: List of the government's plans

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A list of the key plans from the government’s initial response to the Francis inquiry.

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Key recommendations from the executive summary:

The response to the inquiry starts by setting out a five-point plan to “revolutionise” the care people receive from NHS and putting an end to failure:

 

  1. Preventing problems
  2. Detecting problems quickly
  3. Taking action promptly
  4. Ensuring robust accountability
  5. Ensuring staff are trained and motivated

Preventing problems

  • At local level, commissioners will work with hospitals to identify and tackle poor care.
  • A chief inspector of hospitals will look into the culture of hospitals, driving change through fundamental standards and national ratings.
  • To ensure that paperwork, box ticking and duplicatory regulation and information burdens are reduced by at least one third.
  • A single national hub − the Health and Social Care Information Centre − will be  collecting information; with a duty  to seek to reduce information burden on the service year on year.
  • Professor Don Berwick is to work with NHS Commissioning Board (to be known in future as NHS England) to ensure a robust safety culture and zero tolerance of avoidable harm is embedded in the DNA of the NHS.

 Detecting problems quickly

  • Chief inspector of hospitals to make assessments based on judgements as well as data.
  • They will become the nation’s whistleblower.
  • The chief inspector will make an assessment of every NHS hospital’s performance, drawing on the views of inspectors, commissioners, local patients and the public.
  • The inspectors will be specialists not generalists.
  • They will oversee “comply or explain” approach. Good or best established practices that benefit the patients are expected to be used across the hospitals; otherwise a valid explanation needs to be given.
  • The Care Quality Commission will have the power to conduct ratings. It will work with Nuffield Trust to develop these proposals further.
  • Chief inspector to ensure there is “single version of the truth” − single assessment that fully reflects how hospitals are performing, not just targets but also things that matter to patients.
  • “Friends and family” test will be vital component of the ratings.
  • There will be new chief inspector of social care. They will be charged with rating care homes and local care services.
  • Information about hospitals will not be limited to aggregated ratings but it will be possible to drill down to information at a department, specialty care group and condition-specific level.
  • As a starting point, NHS England will extend transparency on surgical outcomes from heart surgery to cardiology, vascular surgery, upper-gastro intestinal surgery, colorectal surgery, orthopaedic surgery, bariatric surgery, urological surgery, head and neck surgery and thyroid and endocrine surgery.
  • Tough penalties and perhaps additional legal action for organisations that are found to be massaging truths or concealing truths about their performance.
  • A statutory duty of candour on providers.
  • A ban on clauses intended to prevent public interest disclosures.
  • A review of best practice on complaints.

Taking action promptly

  • The CQC (with NICE commissioners, professionals, patients and the public) will draw up a new set of simpler fundamental standards which make explicit the basic standards beneath which care should never fall.
  • A new time-limited three-stage failure regime. At the first stage, commissioners will work with the hospital board. In the second stage, if commissioners fail, the CQC will call Monitor or the NHS Trust Development Authority to take action. In the final stage, the chief inspector will initiate a failure regime, if problems still not resoved.

Ensuring robust accountability

Ensuring staff are trained and motivated

  • Healthcare assistant training before nursing and other degrees. Every student who seeks funding for nursing degrees should first serve up to a year as a healthcare assistant (this scheme will be piloted first).
  • Camilla Cavendish is reviewing how to best ensure healthcare assistants can provide safe and compassionate care.
  • Chief inspector will ensure that employers meet their registration requirements that all health and care support workers are properly trained and inducted before they start caring for people.
  • A programme will be initiated by NHS Leadership Academy to encourage new talent form clinical professionals and from outside of the NHS into top leaderhip.
  • An elite fast-track programme and an MBA-style programme to ensure clinicians with a talent for leadership are supported.
  • Frontline experience for Department of Health staff.
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