Today HSJ live will cover our exclusive in depth interview with Robert Francis QC and the debate around it, the first day of the NICE conference, MPs hearing evidence on the NHS reforms, and the healthcare news

HSJ live logo

HSJ live logo

4.55pm: Jeremy Taylor, chief executive of National Voices, has tweeted: Thanks @Jeremy_Hunt for meeting @NVTweeting members today on #Francis. We worry at the emphasis you put on inspection as a lever for change.

4.30pm: Robert Francis QC told he was concerned around the refusal to merge the CQC and Monitor.

He believes merging regulatory functions would prevent a repeat of the communication failure between the two regulators that saw Mid Staffordshire authorised as a foundation trust despite the CQC’s predecessor, the Healthcare Commission, having serious concerns about quality.

The government has rejected the idea of a merger, although it has introduced measures to make the regulators work more closely together.

Mr Francis told HSJ: “What is absolutely vital is there should be no chink at all between the way in which the two things are done. I would still remain concerned at the vulnerability such a system has in having two leaderships, however good they are, because the experience of Stafford shows the way in which two organisations work together does depend quite a lot on the personalities and relationships of the people who run them.

“I’m not sure that necessarily provides the best hope of making sure things are safe.”

3.15pm: During his exclusive interview with HSJ Robert Francis QC said he believe the NHS needed to be more honest about what services it could and could not safely provide.

He said there should be more discussion between the NHS and patients about providing safe services.

“Either you can produce the staff with the money you have got, or you say, ‘I can’t provide the service’.

“I think we have had a culture in the NHS for too long that it doesn’t matter what is thrown at us we will deliver, and actually we have to have a conversation about what you can deliver in a rather more honest way than what has happened before.”

1.50pm: Dean Royles, chief executive of the NHS Employers organisation, has responded to the comments by Robert Francis QC.

On the question of criminal sanctions which Mr Francis said was “only right” Dean Royles said: “The issue of criminal sanction is a complex area that needs careful, thoughtful consideration.

“It’s absolutely right that individuals and organisations are held to account for poor care but we need to be careful of unintended consequences.

“Transparency will be key to driving culture change and we must avoid building a culture of fear.”

Addressing the criticism of nurse leaders Mr Royles said: “I think the nursing profession has taken the brunt of the criticism, with a knock-on effect on morale and motivation of some enormously dedicated and caring nurses.

“I see a lot of activity at local and national level. And I’m sure we will see, with the roll out of national strategies such as Compassion into Practice, an increased focus on staff engagement that will support local organisations to build this caring culture we all want to be part of.”

1.35pm: In HSJ’s exclusive interview with Robert Francis QC, the chairman of the Mid Staffordshire Public Inquiry went further than he has previously on accountability for the senior leaders in the NHS.

He said: “Accountability is not simply a matter of putting someone’s head on a block, it’s actually about the people who are in office taking accountability and accepting the responsibility to put right what went wrong.

“The system has been given a jolt, I would hope, and a very severe warning that things are wrong and there are things that need changing. And therefore they [NHS leaders] have got to change them and if they can’t do that then they shouldn’t be there.”

He said individuals who were named in the report or involved in the events it covers needed to reflect on what happened and their part in it. He added it was right to look at leaders and “not at what they say about it [the report but what they do about it”.

Mr Francis said there was not a “get-out for any individual” from his report, but there were a “wide collection at all levels” who participated in a culture, which contributed very significantly to the appalling care given at Stafford.”

He said everyone in the system needed to “evidence a determination to turn the system round”.

“If they turn out to be people who are unable to understand that or implement that, then questions need to be asked about whether they have a place in that system,” he said.

Mr Francis said he had recommended the Commons health committee review’s progress on implementing his recommendations.

1.30pm: Speaking at a King’s Fund event this morning, Mr Lamb said the local areas that were chosen as pioneers could be offered “flexibilities” around payment mechanisms so that hospitals had a financial incentive to help patients to be supported in community settings.

The Department of Health would take a “permissive approach” to giving the local areas the freedoms that they requested in order to join services up, Mr Lamb said.

He said he wanted the pioneers to be “leaders across the entire system” rather than “pilots where everybody else should stand back and see what’s happening”.

The minister said the NHS would be at risk of “collapse” in the long term if a major shift towards integration did not take place.

“We must integrate or disintegrate,” he said.

At the event Mr Lamb also outlined plans for a new system to measure whether local areas were succeeding in creating joined-up health and care systems. This would be based on measurements of patients’ experiences, he said.

12.55pm: National Voices has welcomed the Government’s aim to make integrated health and social care the norm by 2018.

It has created a new vision for coordinated care, commissioned by NHS England, which shows what coordinated care would look like from the perspective of patients, service users, families and carers.

Don Redding, National Voices’ Director of Policy, said: “Coordinated care is a top priority for patients and service users, such as people with long term conditions and those living with disabilities.

“They, carers and their family members are all fed up with having to navigate a confusing system at the most stressful time of our lives.

12.37pm: NHS England’s Jo-Anne Wass tweets: NHS England appointed Stephen Moir as people director. He is currently at Yorkshire Ambulance Team very much looking forward to him starting

12.02pm: A tweet by James Illman: Lord Howe at #niceconf2013 on Francis: we r trying 2 button down where criminal sanction shd fall. I’m nervous abt it falling on individual

Yes to a duty of candour he says but hes nervous bout it being on ppl rather than orgs.

11.20am: What did Robert Francis QC mean when he told HSJ there should be criminal sanctions for NHS staff who breach new fundmental standards of care? Here is an excerpt from the interview withShaun Lintern:

He said prosecutions would only occur for the most “extreme cases”, and added: “I’m talking about the sorts of behaviour we saw so many distressing examples of in Stafford. Of absolutely appalling care − insulting to human dignity and in some cases life threatening behaviour, leaving people naked, unfed, covered in faeces. These are things which everyone agrees just should never happen.”

He said: “Unless we have a criminal offence we will not be reflecting adequately the gravity of the terrible things it seems are capable of being done in our hospital wards if they are not properly run.

“No one liked to believe such things were possible but they are. If we don’t reflect somehow the fact the public rightly think some things are terrible and there should be real accountability for them, then I believe the public confidence in the NHS will evaporate.

“It hasn’t so far, there is huge resilience amongst the public in terms of its trust within the NHS, but too many Mid Staffords and I am afraid you will find that going, and then what will happen to the NHS I dread to think.”

He said: “If we put in place all the measures I have described in the report there would be an awful lot of stopping points along the way in which people can intervene to prevent these terrible things occurring.

“But without that at the end I fear there won’t be the sufficient focus on it, particularly in the times of financial challenge that we have at the moment.”

11.10am: The Mid Staffordshire Foundation Trust Public Inquiry was significantly delayed and rumours circulated claiming the inquiry had been threatened with legal action.

In his interview with HSJ Robert Francis denied there was any legal threat or that he made significant changes to his report.

HSJ also asked Mr Francis about his reflections on the large number of his recommendations and the length of time he took to produce his report, both of which have been criticised by commentators.

He said he had not “woken up in the night thinking I really ought to have suggested something else or I shouldn’t have suggested something” and added: “I made it clear from the outset I would take as long as I considered it necessary to take.”

Mr Francis said there had been no legal threats to him or attempts to delay the report by those who were criticised. He said while he took representations into account “it would not be right to say things were specifically altered”, and added: “I didn’t remove entire chunks of the report as a result of what I received.”

11am: The BBC reports on a House of Lords debate about the roll out of NHS 111. Health minister Earl Howe says a “number of providers” have delivered an “unacceptable” service and there are problems in the South East and South West. Lord Hunt questions why the decision was made to go ahead with the roll out despite warnings from health professionals and before the publication of the Sheffield University evaluation of the pilot sites.

10.54am: Ali Parsa, former chief executive of private healthcare company Circle, left the board of the company yesterday, Circle reported this morning.

Mr Parsa stepped down from his chief executive role in December to become a non-executive director.

When questioned by the public accounts committee that month about why he had left his former job just months after Circle began its landmark management franchise of Hinchingbrooke Health Care Trust, Mr Parsa repeatedly insisted that he was “not going anywhere” and would remain on the board as a non-executive.

However, a statement issued by Circle’s holding company this morning said “Ali Parsadoust, a non-executive director, will be stepping down from the Board with effect from close of business on 13 May 2013.”

It quoted Mr Parsa as saying: “As the increased commitment to my new ventures requires me to leave the Board, I wish my partners every success in taking this progressive enterprise forward.”

10.45am: In relation to healthcare assistant registration and regulation Robert Francis told HSJ: “Without any registration system or its equivalent I believe the public will be at risk and I am impressed by the fact that virtually every professional group, including HCAs themselves, consider this ought to happen,” he said.

“There seems to be everything in favour of it and if, as one survey suggested, [HCAs] would be willing to pay for it themselves I’m not sure what the problem is.”

He welcomed the government’s commitment to national training for HCAs but he said this was not enough on its own. He said: “We train doctors and nurses and we still like to keep tabs on them afterwards. I think the same should apply with healthcare assistants.”

10.30am: In his interview with HSJ Robert Francis QC revealed his support for NHS Medical Director Sir Bruce Keogh and the suspension of heart surgery at Leeds Teaching Hospitals Trust.

He again urged caution over the use of mortality rates and the numbers of avoidable deaths caused at the Mid Staffordshire Trust.

Mr Francis supported Sir Bruce Keogh saying this was “precisely the approach I would advocate” and added: “There was information that could indicate a cause for concern, if that concern was true then patients were at risk. Therefore the safe thing to do was to call a halt, review the situation and then decide what to do.

“As an approach, stop, look, decide what to do; that seems a sea change from what has happened to date.”

Asked about the use of mortality rates, Mr Francis said: “To assert that no deaths were caused by poor care at Stafford is equally as unacceptable as saying 150 were caused by poor care. It is rather sad we can’t come to a conclusion one way or the other.

“The important thing is not to be diverted by an arid argument about overall mortality rates from the horror of the care being provided to a significant number of patients at Stafford.”

10.15am: Health economies will today be invited to bid to become integration “pioneers” running large-scale experiments in integrated care, in an initiative launched by health minister Norman Lamb.

Read HSJ’s story here.

10.11am: Tweet by HSJ’s James Ilman: Sir Bruce Keogh at #NICECONF2013: we should not be downbeat. We can fix our probs. A great opp ahead of us

10.10am: The Daily Mail splashes on out of hours care for the second day running with a story about GPs being paid up to £1,350 for one shift.

The paper claims Harmoni has been finding it so difficult to fill shifts it has been offering doctors £150 an hour and a £1,000 payment if they refer a friend to work for the service.

The paper highlights the changes to the GP contract in 2004 that meant GPs did not have to work out of hours but reports a statement from health secretary Jeremy Hunt that GPs should not “ ‘necessarily’ be on call at evenings and weekends – as they were a decade ago – because ‘they work hard, they have families and they need a life’.”

10.07am: In other news, HSJ reporter James Ilman is at the NICE Conference today. He has just tweeted that the CQC will do 40,000 inspections this year while it undergoes major internal change.

10.05am: Health Minister Dr Dan Poulter has reacted to HSJ’s exclusive interview with Robert Francis.

In a statement Dr Poulter said: “We’ve been absolutely clear that the Francis Inquiry needs to be a catalyst for change in the NHS - and have swiftly brought in measures to improve the quality of care patients receive and ensure they will be treated with more compassion and respect.

“But in other areas, such as criminal sanctions or a duty of candour on individuals, we need to be careful that we do not unintentionally create a culture in hospitals that is less open, rather than more. We are considering these issues carefully.

“Regulation in itself is no substitute for a culture of compassion and effective supervision. Instead we are focused on recruiting the right people with the right skills for the job, and creating a culture that supports them to give safe care.”

9.55am: You can read the series of stories from HSJ’s exclusive interview with Robert Francis QC by following these links:

Francis concerned about failure to merge regulators’ ‘leadership’

Francis warns recommendations could be lost in ‘long grass’

NHS leaders must make improvements, warns Francis

Francis criticises nursing leaders

9.45am: HSJ reporter Shaun Lintern has exclusively spoken to Mid Staffordshire Public Inquiry chair Robert Francis QC in his first in-depth interview since his final report was published.

He said the absence of an ability to prosecute individual NHS staff in cases of serious patient neglect would cause “public confidence” in the service to “evaporate”.

Mr Francis said of the poor care at Mid Staffordshire: “[It] happened under a regime in which everyone was under a professional duty not to harm their patient. And where did all that get anyone?

“It failed to protect these patients and, if you accept the reports we continue to see from the [Care Qualiy Commission] about dignity and nutrition, it happens on a not infrequent basis.”

He said prosecutions would only occur for the most “extreme cases”, and added: “I’m talking about the sorts of behaviour we saw so many distressing examples of in Stafford. Of absolutely appalling care − insulting to human dignity and in some cases life threatening behaviour, leaving people naked, unfed, covered in faeces. These are things which everyone agrees just should never happen.”

He said: “Unless we have a criminal offence we will not be reflecting adequately the gravity of the terrible things it seems are capable of being done in our hospital wards if they are not properly run.

Read the full interview here.

8.18am: Good morning, mental health and the impact of mental illness on individuals, families and communities is a key focus for the NHS and associated public services, particularly in a time of diminishing resources and increasingly shared services.

Today on HSJ, Juliette Alban-Metcalfe and Jennifer Black write about how by transforming their leadership culture, providers of mental health services can improve the recovery process for patients.