The Francis report's 18 recommendations
The conclusions of the inquiry into Mid Staffordshire Foundation Trust.
The trust must make its visible first priority the delivery of a high class standard of care to all its patients by putting their needs first. It should not provide a service in areas where it cannot achieve such a standard.
Recommendation 2: The secretary of state for health should consider whether he ought to request that Monitor - under the provisions of the Health Act 2009 - exercise its power of de-authorisation over Mid Staffordshire Foundation Trust. In the event of his deciding that continuation of foundation trust status is appropriate, the secretary of state should keep that decision under review.
Recommendation 3: The trust, together with the primary care trust, should promote the development of links with other NHS trusts and foundation trusts to enhance its ability to deliver up-to-date and high class standards of service provision and professional leadership.
Recommendation 4: The trust, in conjunction with the royal colleges, the deanery and the nursing school at Staffordshire University, should review its training programmes for all staff to ensure that high quality professional training and development is provided at all levels to and that high quality service is recognised and valued.
Recommendation 5: The board should institute a programme of improving the arrangements for audit in all clinical departments and make participation in audit processes in accordance with contemporary standards of practice a requirement for all relevant staff. The board should review audit processes and outcomes on a regular basis.
Recommendation 6: The board should review the trust’s arrangements for the management of complaints and incident reporting in the light of the findings of this report and ensure that it:
- provides responses and resolutions to complaints which satisfy complainants;
- ensures that staff are engaged in the process from the investigation of a complaint or an incident to the implementation of any lessons to be learned all part of the recommendation
- minimises the risk of deficiencies exposed by the problems recurring; and
- makes available full information on the matters reported, and the action to resolve deficiencies, to the board, the governors and the public.
Recommendation 7: Trust policies, procedures and practice regarding professional oversight and discipline should be reviewed in the light of the principles described in this report.
Recommendation 8: The board should give priority to ensuring that any member of staff who raises an honestly held concern about the standard or safety of the provision of services to patients is supported and protected from any adverse consequences, and should foster a culture of openness and insight.
Recommendation 9: In the light of the findings of this report, the secretary of state and Monitor should review the arrangements for the training, appointment, support and accountability of executive and non-executive directors of NHS trusts and NHS foundation trusts, with a view to creating and enforcing uniform professional standards for such posts by means of standards formulated and overseen by an independent body given powers of disciplinary sanction.
Recommendation 10: The board should review the management and leadership of the nursing staff to ensure that the principles described are complied with.
Recommendation 11: The board should review the management structure to ensure that clinical staff and their views are fully represented at all levels of the trust and that they are aware of concerns raised by clinicians on matters relating to the standard and safety of the service provided to patients.
Recommendation 12: The trust should review its record-keeping procedures in consultation with the clinical and nursing staff and regularly audit the standards of performance.
Recommendation 13: All wards admitting elderly, acutely ill patients in significant numbers should have multidisciplinary meetings, with consultant medical input, on a weekly basis. The level of specialist elderly care medical input should also be reviewed, and all nursing staff (including healthcare assistants) should have training in the diagnosis and management of acute confusion.
Recommendation 14: The trust should ensure that its nurses work to a published set of principles, focusing on safe patient care.
Recommendation 15: In view of the uncertainties surrounding the use of comparative mortality statistics in assessing hospital performance and the understanding of the term ‘excess’ deaths, an independent working group should be set up by the Department of Health to examine and report on the methodologies in use. It should make recommendations as to how such mortality statistics should be collected, analysed and published, both to promote public confidence and understanding of the process, and to assist hospitals in using such statistics as a prompt to examine particular areas of patient care.
Recommendation 16: The Department of Health should consider instigating an independent examination of the operation of commissioning, supervisory and regulatory bodies in relation to their monitoring role at Stafford hospital with the objective of learning lessons about how failing hospitals are identified.
Recommendation 17: The trust and the primary care trust should consider steps to enhance the rebuilding of public confidence in the trust.
Recommendation 18: All NHS trusts and foundation trusts responsible for the provision of hospital services should review their standards, governance and performance in the light of this report.
Source: Francis report