The government’s full response to the Francis inquiry rejects statutory duty of candour for individual NHS employees.
5.49pm Robert Francis has told HSJ he believes the government’s response to his review of the care scandal at Mid Staffordshire Foundation Trust would be detected earlier in future.
In an HSJ interview he said: “These measures would not have necessarily stopped a Mid Staffs from beginning to happen but it would have been detected much more quickly.”
He appeared relaxed over the government’s decision not to implement all of his recommendations, suggesting it was legitimate his intentions were achieved in different ways.
5.15pm More from the HSJ news team:
The Care Quality Commission is to get power to investigate board directors of all NHS providers to establish whether they are “fit” to hold the position, it has been announced.
The government has rejected a plan by Robert Francis QC to force councils to hand centrally-allocated funding directly to local Healthwatch groups, arguing that councils should be free to decide the groups’ funding.
A major patient safety improvement programme and new incident report and alert systems are to be introduced by NHS England in response to the Francis inquiry.
5.08pm Our news team hasn’t finished analysing the government’s response to Francis yet.
Here are the most significant parts of the government’s response, so you can read the relevant parts without having to sift through 290 separate findings.
4.34pm Back on Francis, Unite has responded angrily to the government’s response.
Head of health Rachael Maskell said: “What Jeremy Hunt outlined won’t disguise the fact the public and staff can see there are not enough nurses.
“Are managers going to rob pathology to put a nurse on the ward, and then we will have a failed diagnosis scandal?”
She then launches into an elaborate mixed metaphor: “While the NHS descends into the mire of privatisation, the health environment has become unsafe, as Hunt continues to fiddle and dither. He has yet to get to grip with how the so-called ‘health reforms’ are contributing to the patient safety scandal.
“The toxic meltdown of the NHS is caused by cuts and privatisation, and therefore Hunt’s response can’t be used as a sticking plaster to obscure the real nature of the crisis.”
4.28pm While attention has been trained on Westminster with the government’s response to Francis, NHS England has put out its draft commissioning policies for non specialised services.
The interim policies will be “of particular benefit to the armed forces and health and justice populations”, NHS England says. This is because “members of these communities, particularly serving armed forces personnel and their families, are subject to changes in location which may disrupt the provision of their healthcare.”
There are 37 policies in all. Click here to read more.
4.16pm HSJ has been pulling out news lines from the government’s response to Francis all afternoon. Here are three more stories:
- “A new industry of internal investigation” could be created by plans to strip trusts of their government indemnity cover if they break duty of candour rules, a leading NHS lawyer has warned.
- Allocating named or key nurses to individual patients is not to be made mandatory, under the government’s response to the Francis report.
- National bodies should reduce the amount of data they collect from NHS providers by 10 per cent over the next two years and contribute to the cost of any new information requests, a review of bureaucracy in the NHS is set to say. The review was set up by the government in the wake of the Francis report. It estimated nationally required data collection and processing costed providers between £300m and £500m annually.
3.56pm Here are the key lines from the NHS Confederation.
Director of policy, Dr Johnny Marshall, said: “The NHS has not sat back and just waited for today’s report though; we have already been making changes in response to the concerns raised by Robert Francis. In June, 91 per cent of chief executives and chairs said they had already made ‘good’ or ‘reasonable’ progress in setting out how they would respond to the Francis Inquiry’s conclusions.”
- On safe staffing levels:
“Crude national ratios around nursing numbers risks hitting the target, but missing the point… We therefore support the local flexibility to have the right people, in the right place, at the right time.”
- On the duty of candour:
“We value an open and transparent NHS; an NHS in which we have an environment where managers, staff and patients are encouraged to speak out if they have concerns.
“We welcome measures to make the NHS more open and accountable and absolutely support a duty of candour at an organisational level… We have always argued that this duty should apply to organisations rather than individuals because threatening individuals with legal action is not the right way to encourage them to speak out about failings.
- On the proposed fit and proper persons test:
“Good leadership is essential for quality patient care and it is right that managers, just like clinicians, should face the consequences if they are not up to the job.
“However, as well as rooting out poor leadership, we need to highlight the good work that occurs every day, and recognise the challenges leaders face, particularly in the most troubled organisations.
“We are encouraged that a fit and proper person test for senior posts recognises the important role of leaders in the NHS to drive forward culture change and improvements. The detail of how it is to work in practice will be absolutely critical. We must avoid any increase in the ‘blame game’ which Robert Francis warned against.”
3.44pm There’s also a highly comprehensive statement from the NHS Confederation. Bear with us, we’re just picking out the key points now.
3.42pm Another couple of important comments on the government’s response to Francis.
First, this, from the Catherine Foot, assistant director of policy at the King’s Fund: “We welcome today’s focus on making honesty and transparency the guiding principles for patient safety. Implementing the change set out by the government will be a long haul and requires culture change right across the NHS. This will take place against a backdrop of severe financial pressure, with NHS organisations already facing difficult decisions about whether to prioritise patient care or balance the books.”
“We need to be realistic about what can be achieved by Whitehall and regulators alone. Leaders within NHS organisations are best placed to foster a culture of compassionate care through motivating their teams, creating an open environment where mistakes are learnt from, and ensuring that candour permeates from the board room to the ward.”
“The government is right to emphasise the importance of safe staffing levels and to recognise that these should be locally determined and justified. Boards need to be assured that their staffing ratios are adequate but staffing levels are only part of the answer in creating a culture of compassionate care. Likewise, criminal sanctions against wilful neglect will provide an important legal backstop in the worst cases of poor care but again they are only part of the solution.”
“Today’s announcement is an important step forward in addressing the serious failings of care highlighted in the Francis report. Patient safety is more important than party politics and what is needed now is for everyone, from parliament to the frontline, to unite around delivering the culture change needed.”
“We welcome today’s focus on making honesty and transparency the guiding principles for patient safety. Implementing the change set out by the government will be a long haul and requires culture change right across the NHS. This will take place against a backdrop of severe financial pressure, with NHS organisations already facing difficult decisions about whether to prioritise patient care or balance the books.”
3.05pm Time for a round up of today’s events:
- Ministers have rejected nine of Robert Francis’ 290 recommendations.
- A further 20 recommendations were accepted in part, while 57 were accepted in principle only.
- The statutory duty of candour will only apply to organisations. Individuals will be regulated via the professional codes for doctors and nurses.
- Trusts that don’t stick to the duty of candour face losing their litigation cover.
- Trusts also face a new “willful neglect” offence.
- The government’s response has been widely welcomed by the royal colleges and clinical regulators.
- There will be no centrally-set, mandatory nurse to patient ratios, but trusts will have to publish regular ward data on staffing.
2.53pm Sir Richard Thompson, president of the Royal College of Physicians, has welcomed the government’s response to the Francis report. He said: “It is encouraging that the response emphasises the setting and monitoring of quality standards in healthcare.
“The government acknowledges the contribution of the medical Royal Colleges and their trainees, and underlines that they must in future be fully involved in defining quality standards. We agree, and look forward to continuing our existing work in this area, and undertaking new programmes and projects to try to ensure that the failings of care at Mid Staffordshire NHS Foundation Trust never happen again.”
2.49pm The government’s Francis response confirms that never events will be published monthly, broken down by trust.
This moves the policy on from its position in September, when HSJ reported that the most serious incidents would be publically reported “on a quarterly basis”, after an NHS England Freedom of Information Act response.
2.30pm We’ve been through the government’s response to Francis and found each of the report’s recommendations that the government have rejected. Click here to find out which ones they are.
Incidentally, we make nine rejections out of 290 an acceptance rate of 96 per cent, with the caveat that some were only accepted in part or in principle.
2.25pm One final response for now - we’ll do another round up in a little while.
NHS Clinical Commissioners interim President Michael Dixon said: “The old system which allowed an outrage such as Mid Staffs to happen must be consigned history. Blind obedience to the centre cannot deliver patient safety; indeed it will deliver a culture that ensures bullying, lying and gaming of targets.
“The only way of ensuring patient safety and also developing a system which is built on ever increasing quality is to put power in the hands of local clinicians and communities. The logic of the new system established by the Health and Social Care Act is one where clinical commissioners will only commission from providers who are responsive and deliver high quality services for patients.
“Our concern is that a new edifice is being constructed that risks making similar mistakes to ones made before. Regulation and regulators cannot guarantee quality; who can are local commissioners who are committed to ensuring and assuring the quality of all providers in their area. Change depends on local leaders and staff who are committed to quality and ensuring that appropriate care is provided the first time around.”
2.20pm A response has arrived from the Royal College of Nursing.
Chief executive and general secretary Dr Peter Carter said he was pleased that the government was acknowledging the importance of staffing levels, and that the moves towards greater transparency on ward staffing goes “some way to ensuring that each hospital in the country offers patients access to the care they deserve.”
However, the announcement of 3,700 nurses to be hired is only “a start”, as the RCN claims 20,000 posts are unfilled.
Dr Carter said: “We also welcome the focus on consistent training for health care support workers through the Care Certificate. Although we remain convinced that the mandatory regulation of all health care support workers is the most effective way of protecting patients, the announcement today is an important first step.”
The RCN questioned whether criminal sanctions for willful neglect were necessary.
The college made no comment on the recommendations that it be split into two organisations (see 1.25pm, below).
2.14pm Nursing and Midwifery Council chief executive and tegistrar Jackie Smith has said: “We particularly welcome the commitment to legislate at the earliest opportunity to provide all healthcare regulators with a modern and efficient legal framework. We believe this will make fitness to practise faster, more efficient and more effective. With the proposed legislative changes, expected to be by 2017, we can aim for concluding most concerns within 12 months. This is what the professions and the public would expect and we are committed to delivering it once the changes take effect.”
2.08pm A note of dissent from Unison: the government’s response to Francis doesn’t go far enough in getting to the heart of the issues in Mid Staffordshire, which the union says were about staffing levels, culture and engagement.
Unison says the government’s response to Francis is a “step forward for the NHS”, but it stops short of making “some potentially life-saving changes”… “simply requiring hospitals to publish, and boards to examine, staffing levels just does not go far enough.”
Head of health Christina McAnea said: “The government has missed another opportunity to introduce fixed, safe nurse to patient ratios. There is safety in numbers when it comes to caring for patients and this one step would bring about a revolutionary change on the wards. Recommending a “toolkit” to set minimum staffing levels is fine, but what will happen if these are ignored when wards are under pressure, which is almost a daily occurrence in today’s NHS?
“It shames this government that it has waited so long to announce that it is to recruit 3,700 more nurses – which still falls short of the 6,000 that have disappeared from the NHS since the Coalition came to power. There is no doubt that some hospitals have become dangerously under-staffed because of government cuts. It has ignored the warning signs and the calls from hospital managers, staff, patients and unions that more nursing staff were needed urgently.
“The focus on nurses is understandable, but it must not be forgotten that the culture of NHS organisations is dependent on the whole healthcare team. It is important that issues of staffing levels and skill mix are considered on an organisational basis and not just within the nursing directorate.
“The government says it has accepted the thrust of the recommendations in the Cavendish report, but disappointingly it is not supporting regulation for health and social care assistants. The proof of government intentions will also be dependent on whether it funds these developments such as training and improved pay.
“The response gives a framework for some welcome changes but I am not sure that it gets to the heart of the issue - which is about the culture and staff engagement.
“The statutory duty of candour is rightly being placed on the organisation, not on individuals. This will enable staff to speak out more freely and safely - without fear of reprisals. But we have concerns about a blame culture with blacklisting hospitals which goes against promoting openness and candour.”
1.58pm Niall Dickson, chief executive of the General Medical Council, said: “We all need to step up to the challenge of the Francis report - patients should always be at the heart of healthcare but we know this is not always the case. We welcome the Government’s response and in particular the emphasis on greater consistency between healthcare regulators.
“Through our guidance, we have already done a great deal to encourage a duty of candour among doctors, but we are not complacent. We know there is more to do. We must strengthen the link between our guidance and doctors’ practice on the frontline, the words on the page and actions on the ward. We look forward to working with doctors and others to make that happen.”
1.56pm The Academy of Royal Medical Colleges has published a lengthy statement in response to today’s announcement from the government.
Academy chair Professor Terence Stephenson welcomed the government response, and the “detailed deliberation” it contains.
“The Academy is happy to take forward those specific recommendations where we are called on to take action by the government, he added.
“Doctors and medical Royal Colleges recognise the failings at Mid-Staffordshire must not be allowed to happen again. The Government’s response provides the framework for medical Royal Colleges individually and the Academy of Medical Royal Colleges collectively to continue the work already under way to help ensure this is the case.”
1.51pm More responses: The Royal College of Midwives has broadly welcomed the government’s response to Francis.
A statement published this afternoon says the “focus on staffing levels vindicates what the RCM have been saying for many years about the dangers of a serious shortage of midwives”.
Meanwhile, “the explicit commitment to ensure that trusts meet safe staffing guidelines using models approved by NICE is welcome. A tool to calculate safe staffing levels already exists for maternity services and we look forward to working with NICE with a view to this being endorsed.”
The RCM is also positive about the duty of candour for individuals being built into professional codes of conduct, and that there are criminal sanctions available for the “very small minority of health professionals” who have deliberately mistreated patients.
Cathy Warwick, chief executive of the RCM, said: “Overall this is a robust and comprehensive response by the government. Safety, staffing and openness and transparency should be at the heart of the NHS.
“If the government really follow up their commitments in this response then I hope we will see an even safer and better NHS and, a maternity service that has the right number of staff, with the right skills. This will lead to better care for the millions who rely upon the NHS to safeguard themselves and their loved ones, and who place their lives in its hands.”
1.44pm Health sector lawyers have been tweeting about the impact of the statutory duty of candour on private sector providers.
They tweet: “we think it will apply to independent sector providers if providing NHS care.” Asked whether this would apply to all activities and staff even where the provider only treats one NHS patient, they went on: “not clear. We think through commissioning contracts, so maybe guidance to follow from NHS England?”
1.32pm Dr Mark Porter, chair of the British Medical Association, has agreed with the the government that safe staffing levels should not be centrally mandated, and welcomed the government’s line on the duty of candour.
He said: “What happened at Mid Staffordshire was totally unacceptable and we support the government’s commitment to put patient care first and foremost, while at the same time looking to create a culture of support - not blame - to empower staff to raise concerns and drive through change.
“Patient safety should always be paramount, which is why safe staffing levels should always be set in accordance with the best available evidence and with a dynamic consideration of patients’ needs at any one time.
“Centrally imposed mandatory staffing levels would be difficult to implement as they fail to recognise that not every patient is the same and, as such, safe levels will vary from time to time across hospitals. The government is right to want to deal with this through a combination of evidence-based guidance, rigorous governance, transparency and openness.
“We are also pleased that the government has heeded the BMA’s warnings over the introduction of a statutory duty of candour for individuals, instead strengthening the professional duty that already exists. It is vital that organisations actively listen to their staff and take on their concerns.
“While extending wilful neglect as a criminal offence may go some way towards reassuring the public, it is unlikely to bring around the change in culture we need, and how this will work in practice is something that we will continue to discuss with the government as there are already criminal sanctions in place in order to hold healthcare workers, including doctors, to account.
“Doctors play a vital leadership role across the NHS in driving forward change and we hope that doctors will be given a real voice in helping to meet the challenges the NHS faces in becoming an organisation that truly listens to both its patients and staff.”
1.31pm Responses are now pouring in. Jeremy Taylor of National Voices says the government has not gone far enough on the statutory duty of candour, and has urged a rethink from the DH: “The government has done a thorough job in responding to Francis, in particular by beefing up regulation, inspection, reporting and accountability requirements. We welcome the seriousness of the effort but experience suggests we should be cautious about the likely impact of such measures on improving care.
“The real transformation of care quality is more likely to come from strong local leadership in trusts, open supportive and learning management cultures and a willingness to work in partnership with patients, their families and communities. That remains a challenge and work in progress. Regulation and inspection can help but also hinder.
“We welcome a commitment to a statutory duty of candour when things go wrong but think it does not go far enough. By limiting candour to cases where death or the most serious harm has occurred, the government is essentially legitimising continued cover-ups in many other circumstances. We are urging the DH to rethink this.”
1.25pm The government have accepted Francis’s recommendation that the RCN should be split into two separate organisations. No word yet from the RCN, but they have previously said no.
1.23pm Here’s the government’s official response to Francis: each recommendation responded to, one at a time.
1.20pm PoliticsHome editor Paul Waugh tweets: “The Francis truce seems to be holding so far, @Jeremy_Hunt + @andyburnhammp dealing with each other civilly despite differences”. This is note-worthy as previously Mr Hunt has laid some of the blame for Mid Staffs at the feet of Mr Burnham, who was previously Labour health secretary.
1.18pm There appears to be some confusion over how far the statutory duty of candour will extend. For clarity: it will only apply to organisations - it will not apply to individual doctors and nurses.
1.16pm NHS England have published their response to the government’s response to Francis.
Here’s what they’re going to do:
- Launch “Patient Safety Collaborative Programmes” in a network covering the entire country. These will bring together frontline teams, experts, patients, commissioners and others “to tackle specific patient safety problems as well as learning from each other to improve safety.”
- Create an “NHS Improvements Fellows programme” – appointing 5,000 fellows within five years who will be champions, experts, leaders and motivators in patient safety and will help the collaboratives devise and implement solutions. This sounds not unlike the earlier “care makers” policy.
- Make patient safety data more accessible – “ensuring up-to-date information on patient safety issues, including staffing, pressure sores, falls and other key indicators will be available at the fingertips of patients.”
- Publish never events data – “and by so doing for the first time placing the NHS as a world leader among health services in terms of openness and transparency.”
- Re-launch the “Patient Safety Alerts System” – giving a clearer framework for organisations to understand issues and take rapid action when responding to patient safety risks.
1.10pm Shaun Lintern reports: The government has rejected the idea of applying a statutory legal duty of candour to individual doctors and nurses Instead, ministers plan to include a new explicit duty in the professional codes for doctors and nurses.
At a press conference this morning, Mr Francis said that, while he accepted the government approach, “we need to keep a close watch on this particular area. If we keep hearing about these behaviours [such as stifling whistleblowers] in the future then I will still be saying we need a criminal sanction.”
1.08pm Of the 281 Francis recommendations accepted by ministers, 57 have been accepted in principle, and a further 20 accepted in part.
1.06pm More on those Francis recommendations rejected by the government: Three relate to the regulation of healthcare assistants. The government has also decided against adopting in full Francis’ recommendations in relation to a statutory duty of candour, and making it a criminal offence to obstruct healthcare professionals from exercising a duty of candour, as recommended by Mr Francis.
However, the government plans to address both of these issues by strengthening professional codes of conduct.
1.04pm Launching the government’s full response to Francis, health secretary Jeremy Hunt said the public inquiry report and the actions that will follow it would be “completely transformational in terms of its impact on the NHS”.
“There’s a real sense of the culture of the NHS beginning to change,” he added.
On the new requirement for trusts to publish staffing levels on their wards, Mr Hunt said the government recognised it was not possible to deliver good care without safe staffing levels. Although the government had looked carefully at the evidence for delivering a minimum staffing level from the centre, ministers had decided the necessary numbers would be different for different wards.
Mr Francis, who was also at this morning’s press conference, described the response as “carefully considered and thorough response”.
1pm BREAKING:Health secretary Jeremy Hunt has announced NHS trusts could be stripped of the indemnity cover provided by the NHS Litigation Authority if they are found not to have complied with a new statutory duty of candour.
12.46pm HSJ editor Alastair McLellan tweets: To get full value from HSJ’s unequalled coverage of the Gov’s response to the #Francis report for FREE you need to the following 3 things…
1) Register to read HSJs’ coverage for free at https://www.hsj.co.uk/register/
3) Keep a close eye on our rolling news blog: HSJ Live.
12.16pm One outstanding Francis issue: what will the government do about his recommendations for the Royal College of Nursing? Robert Francis’s report, published in February, advised that the RCN’s trade union and professional college functions should be separated. It will be interesting to see what ministers have decided.
12.13pm It’s probably worth mentioning that Simon Wessely, who has criticised the government’s plans to scrap GP catchment areas in the Guardian today (see 11.19am, below), is the husband of Clare Gerada, outgoing chair of the Royal College of GPs.
11.59am Our reporter Sarah Calkin has produced a string of stories about the government’s response to Francis over the past week.
To help you catch up with them:
- A group set up by the government has urged ministers to consider dropping its plan to set up a barring scheme for NHS managers guilty of misconduct. Robert Francis QC recommended a system in which executives and non-executives faced disqualification from holding similar positions in future in cases of incompetence or serious misconduct. Health secretary Jeremy Hunt proposed the introduction of a scheme similar to that used for teachers in the government’s initial response to the Francis report in March, but the “leadership standards task and finish group”, set up by the DH to review the proposals, reported it was “not fully convinced” a barring scheme was a proportionate solution.
- Here’s our story on the plan to publish ward staffing data, which we broke a week ago.
- NHS providers should recruit more staff if their current workforce plans do not take account of staff training and unplanned leave.
- Senior nurses are divided over the issue of minimum ward staffing levels.
11.35pm In our Comment hub, Kate Rohde argues “clinical negligence lawyers can contribute to an intelligent debate about how an environment of transparency and openness, supportive of both patients and professionals, can evolve”.
11.34pm Our commentator Michael White is concerned at the amount of ministerial activity around health policy.
Ahead of this afternoon’s government’s response to the Francis report he writes: “Nowadays rarely a week passes without a major announcement from health ministers. It is as if a tornado is on a permanent rampage through Whitehall. It wasn’t meant to be like this, but it often reminds me of the Thatcher era when the then PM’s rhetoric was all about setting industries and public services free from the stifling state. Yet it often seemed to involve a lot of central interference.”
11.21am Jeremy Hunt’s statement has been moved back to 1pm, according to the usually well informed Patrick Leahy, the Royal College of Surgeons head of public affairs.
11.19am The Guardian also has this comment piece on Jeremy Hunt’s plan to let patients register with any GP anywhere. Simon Wessely asks: “what’s not to like?” Then, he answers: “For some, rather a lot”, as the policy potentially breaks the link between the GP practice and their local population, which will led to some practices being oversubscribed and will force GPs to choose which patients they accept.
11.07am The ward staffing levels story seems to have been briefed to the nationals’ lobby journalists, not the health reporters. The Guardian’s version, by political editor Patrick Wintour, is buried on page 19 this morning.
The Daily Telegraph’s take appears to have been briefed out to one of their senior political journalists too.
The Telegraph also has another story highlighting a number of hospitals ignoring safety guidelines for a specialist operation on aortic aneurysm repairs.
Data analysts Dr Foster have said that 21 NHS trusts are continuing to perform abdominal aortic aneurysm repairs even though they carry out too few operations to meet clinical standards, their story says.
Experts recommend that hospitals carry out a minimum number of such highly technical operations to make sure that surgeons’ skills are up to date - the Vascular Society recommends that over a three-year period each hospital trust which performs aneurysm repairs should conduct at least 100 operations to maintain skill levels.
10.46am Some parts of the government’s response to Francis have been widely trailed in the press over the past few days.
The Times reports that hospitals will be made to publish ward staffing levels once a month. The goal is ultimately to publish real-time data on whether hospitals are falling short of safe care. Hospitals with consistently low levels of staff will face inspection by the Care Quality Commission.
10.38am A couple of new stories on HSJ this morning: Many of England’s maternity services run at a deficit and have to be subsidised by other departments, the Foundation Trust Network has told MPs. The Public Accounts Committee demanded explanations from senior health officials after a National Audit Office report highlighted a shortage of midwives and consultants on labour wards and found that a fifth of funding was spent on insurance against malpractice.
And, ministers should consider extending prescription charges, as well as introducing new charges on visits to NHS GP surgeries and some elements of hospital care, to raise £3bn a year for the health service, the Reform think tank has said.
In a report, Reform noted that many other countries charge for elements of healthcare which are free at the point of use in England. New charges on a greater range of prescriptions could raise £1.4bn, charges for GP visits £1.2bn and hospital care charges £200m, the study found.
Reform’s former deputy director, Nick Seddon, is now the Prime Minister’s senior advisor for health.
10.35am Our reporters Sarah Calkin and Shaun Lintern are down at the Department of Health for the launch of the government’s response to Francis.
Shaun tweets: “Robert #Francis has arrived at the DH. Does that mean he has signed off on the Govt response to his report?”
Our panel is: Professor Sue Bailey, president, Royal College of Psychiatrists; Andy Bell, deputy chief executive, Centre for Mental Health; Stephen Dalton, chief executive, Mental Health Network; Dr Quazi Haque, medical director, Partnerships in Care; Paul Jenkins, chief executive, Rethink Mental Illness (chair).
10.23am A couple of other things going on at HSJ today: the HSJ Awards will be announced tonight. The shortlist is here, and the full results will be published online tonight. You can also follow the ceremony live on Twitter at #HSJawards.
10.13am Click here to catch up on all our latest Francis coverage. We’ll be adding stories throughout the afternoon today, but there’s already plenty there to read, as we’ve been breaking stories about the government’s full response since last week.
10.10am As today will be dominated by the debate on poor care, and the failure of NHS leaders to do anything about it, this story could not be more relevant. Our east of England reporter James Illman reveals that Colchester Hospital University Foundation Trust faces fresh claims that senior managers put pressure on staff to alter data.
The new claims, from nurses, suggest the alleged problems at the Essex trust could go beyond the oncology department which is already facing a police investigation over allegations that cancer waiting time data was altered.
9.55am The government’s full response to Francis is expected to be published at 1pm today, following a speech in the House of Commons by health secretary Jeremy Hunt at 12.30pm.
In advance of that, here are some themes we suggest you look out for:
- Criminal sanctions for NHS workers where care fails to meet basic standards: Will the “duty of candour” apply to individuals? Will it apply only where patients have died or in all cases of severe harm? What will those sanctions be? Will there be new protections for whistleblowers?
- HSMR/mortality ratings: Will ministers accept Francis’ recommendation that these be treated as an official statistic? HSJ sources suggest this is likely. And, will they use the HSMR scores or will NHS England reveal a new mortality measure?
- NHS managers: What will the “fit and proper persons test” for NHS managers look like? Will there be a barring scheme for managers judged not to measure up, or other forms of enforcement?
- Nursing: Will there be regulation for healthcare assistants? This is not thought likely. Will it be confirmed that NICE should draw up guidelines for safe staffing levels? The government had previously suggested that nurses carry out a year of basic HCA-style work as part of their training - it will be interesting to see whether there’s an update on that policy. An what will be be the final word on the recommended minimum ward staffing level of one nurse to every eight patients. Trusts will be anxious to see whether the Department of Health will make more money available to them if they find they need more nurses.
- Complaints: Will there be any new policies on how NHS organisations should handle complaints from patients and families?
9.47am All our Francis coverage is free to registered users today, until this evening. Sign up free of charge here.
9.45am Good morning. Today the government publishes its full response to the Francis inquiry. We’ll be following all the key developments throughout the day on this liveblog - stay tuned for updates.