A summary of Sir Robert Francis' public enquiry into Mid Staffordshire NHS Foundation Trusts and what it means for trainees
Dr Martin Rooms (SpR)
The Francis report was published in Feb 2013 on the back of a previous inquiry by Robert Francis QC published in Feb 2010 and the preceding Health Care Commission (HCC) investigation into failings in the standard of care and higher than expected mortality rates at the Mid-Staffordshire NHS Foundation Trust.
The aim of the report was to investigate how and why these failings had not been identified or been allowed to persist by senior management and the various external agencies commissioned for such a purpose.
The inquiry examined over a million documents and took statements from multiple sources including patients, clinical staff and management.
It’s findings identified a disconnect between the Trust board’s focus on targets, finances, the achievement of Foundation Trust status and the effect these were having at a clinical level. A rift between management and clinical staff was seen to be evident. Similarly, management did not listen to the feedback coming from the patients of the Trust.
The inquiry identified that the board had the wrong priorities and their main focus was on the financial challenges facing the trust and a lack of focus on standards leading to an inadequate risk assessment of the effect of staff reductions. This was compounded further by the lack of a clinical governance system, described as “vestigial”, which was unable to inform the board of the failings that were occurring.
The Trust was also felt to be defensive in reaction to criticism and lacked insight and openness whilst handling their problems.
The examination of multiple external watchdog agencies (HCC, Monitor, SHA and more) identified that “regulatory gaps between agency remits, lack of effective communication and constant reorganisation led to a systemic culture where organisations took inappropriate comfort from assurances given by the Trust and from action taken by other organisations.” These problems were, at least in part, created by the “constant re-organisation of NHS structures leading to loss of corporate memory, misunderstanding about organisations functions and responsibility.”
All the above allowed inadequate care and poor standards to be tolerated in an atmosphere of low morale.
In all The Francis Report list 290 reforms and suggestions to improve the situation described above in order to address failings at all levels of the NHS, from clinical staff to the external agencies that regulate the service. The recommendations included the concept of Trust board responsibility for the clinical service provided and reforms to address the disconnect between the layers of management and oversight agencies with those providing clinical care.
The overall themes of these reforms are as follows:
- Emphasis on and commitment to common values throughout the system by all within it;
- Readily accessible fundamental standards and means of compliance;
- No tolerance of non-compliance and rigorous policing of fundamental standards;
- Openness, transparency and candour in all the system’s business;
- Strong leadership in nursing and other professional values;
- Strong support for leadership roles;
- A level playing field for accountability;
- Information accessible and useable by all allowing effective comparison of performance by individuals, services and organisation.
The inquiry stipulate specifically, however, that it does not think a root and branch re-organisation would be useful but for reform within the current system to put the care of the patient at the forefront for all those within the NHS.