Government response to the Francis Report

Robert Francis QC was tasked by the government to hold a public inquiry looking into the Mid Staffordshire Foundation Trust hospital. The inquiry heard from patients, staff, trust board members, chief executives, trade unions and politicians.

Robert Francis QC published the second of his reports on 6 February 2013.

The RCN made this statement following the report’s publication.

Prime Minister David Cameron made a statement to the House of Commons on the day of the report’s publication informing Members of Parliament that the government would digest the recommendations and respond accordingly by the end of March.

On 26 March 2013 the Secretary of State for Health Jeremy Hunt did just that and made a statement in the House of Commons outlining the government’s detailed reaction to Robert Francis’ report. He announced series of measures which will be enacted as a result of his findings.

The Government did not respond to each of Robert Francis’ recommendations, instead it chose to respond thematically. The Secretary of State announced that the Government would issue further documentation in response over the coming months.

The Government’s response is divided in to five areas:

• preventing problems
• detecting problems quickly
• taking action promptly
• ensuring robust accountability
• ensuring staff are trained and motivated.

Key announcements were made with regards to the way in which nurses are trained and selected for education placements, as well a new system of ‘ratings’ for all hospitals and trusts.

One of the most prominent and radical announcements involves the training of prospective nurses. The Government has proposed that before students are accepted onto a nurse training course they must have undertaken work as a health care support worker (HCSW) for at least one year. The report states:

"Starting with pilots, every student who seeks NHS funding for nursing degrees should first serve up to a year as a healthcare assistant, to promote frontline caring experience and values, as well as academic strength. Health Education England will work with the Nursing and Midwifery Council, professional leaders and trade unions in developing the pilots."

The RCN is very concerned about this recommendation and has called for more information to be made available as soon as possible. This proposal has great implications for our current nursing and health care support worker workforces as well as nursing students and prospective nursing students.

Despite pressure from the RCN, other stakeholders, and specific recommendation by Robert Francis, the Government have announced that mandatory regulation for health care support workers will not be introduced. Instead, a code of conduct and minimum training standards have been published which HCSWs will have to adhere to. It was announced in the Government’s response that a newly appointed Chief Inspector of Hospitals and the Chief Inspectors of Social Care will ensure that all HCSWs are properly trained and inducted.

The Francis report explicitly stated that poor staffing levels at Mid Staffordshire led to poor quality care. Whilst the government concedes that adequate staffing levels are essential in providing proper care, they will not introduce mandatory staffing levels. The Government has charged NICE with developing staffing levels and skill mix tools to be used by employers to calculate appropriate staffing levels.

To ensure robust accountability, the Government will consider the introduction of additional legal sanctions – a duty of candour – at corporate level. At present, individuals will not face criminal sanctions, a proposal of Robert Francis, however, this has not been ruled out and the government will wait until Don Berwick’s report into zero harm in the NHS.

The Government also announced that the Nursing and Midwifery Council (NMC) will introduce a nurse revalidation scheme for already qualified nurses to ensure all are up to date and fit to practise.

The Government’s response stressed and acknowledged the importance and role of the supervisory ward sister in providing good quality care and training to nurse students.

The Government also responded to recommendations in the Francis report with regards to the role of the RCN. The report states:

"The Royal College of Nursing has an important role in developing and promoting the art, science and practice of nursing. The Government believes a clearer distinction between its professional and trade union roles, both important, would enhance the authority of its work."

The RCN issued this statement following the government’s response.

The RCN will be issuing a detailed response to the report’s findings in the near future.