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The Francis Report - How Are We Improving?

Francis Report - Nurses (November 2013)

On Wednesday, February 6, 2013, Robert Francis QC, Chairman of the Public Inquiry into the events at Mid Staffordshire NHS Foundation Trust, published his final report following consideration of over 250 witnesses and over one million pages of evidence.

The Inquiry had been examining the commissioning, supervisory and regulatory bodies in the monitoring of Stafford Hospital between January 2005 and March 2009. It had been considering why the serious problems that occurred there were not identified and acted on sooner, and identified important lessons to be learnt for the future of patient care.

The Inquiry identified a story of terrible and unnecessary suffering of hundreds of people, and Mr Francis subsequently made 290 recommendations to the Government designed to ensure that events like those at Stafford are never repeated.

The very clear message from the report was that improvements should be driven by cultural change which puts patients first.

On Tuesday, November 19, 2013, Health Secretary Jeremy Hunt announced the Government’s response to the public enquiry, saying that he had fully or partially accepted all but nine of the 290 recommendations.

Since the publication of the Francis Report in February, Mid Cheshire Hospitals NHS Foundation Trust (MCHFT) has been working closely with patients, public and staff to establish where improvements can be made locally.

The February 2013 report was the second report published by Robert Francis into the care provided at Stafford Hospital. Following the first report, which was published in February 2010, MCHFT had developed a robust action plan to address any issues. This plan was fully implemented and was subsequently reviewed prior to the release of the second report to ensure that the actions taken were fully embedded.

In Spring 2013, the Trust heard from its patients, public and staff regarding occasions when it had got things right, when things could have been done better, and where it should focus on further improvements going forward.In developing its local response to Francis’ recommendations, the Trust undertook a number of actions, including:

  • reviewing recommendations from a number of reports, namely:

- Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry, led by Robert Francis QC (February 2013)

- Review into the quality of care and treatment provided by 14 hospital trusts in England, led by Professor Sir Bruce Keogh (July 2013)

- An Independent Review into Healthcare Assistants and Support Workers in the NHS and social care settings, led by Cavendish (July 2013)

- Improving the Safety of Patients in England, led by the National Advisory Group on the Safety of Patients in England, also referred to as the Berwick Report (August 2013).

  • holding public consultation events in response to the Francis report.

  • holding consultation events with staff.


Francis Report - MCHFT Arrows (November 2013)
Francis Report - MCHFT Culture (November 2013)

After reviewing the national reports, six key themes were identified around the overarching topic of changing the culture within the hospital environment:

  • having common values;ensuring that staff (and the organisation as a whole) are open and transparent with patients;

  • having strong patient-centred leadership;

  • having fundamental standards of care;

  • ensuring that staff are compassionate, caring and committed;

  • providing accurate, useful and relevant information wherever possible.



The above themes have been considered alongside the comments received by patients, staff and the public, and an analysis has taken place which demonstrated that many of the recommendations were already in place and had been for some time, whilst a gap analysis has identified the remaining areas for further improvement. An updated Quality and Safety Strategy for 2014-2016 (PDF document, link opens in new window) has recently been developed and is driven by the elements identified in the reviews and consultations. This is being supported by a new Organisational Development Strategy (PDF document, link opens in new window), which also contains important lessons learnt from the review.

Following the Government’s response in November to the Francis report, the Trust is now in the process of building their recommendations into its response.

The Trust feels strongly that listening to the voice and experience of patients is the best way of ensuring continuous improvements that are responsive and effective. MCHFT strives to be open and transparent and already works closely with patients and carers in its approach to learning and the design of services.

The Trust has an active Council of Governors, currently consisting of 27 elected and appointed Governors covering patients, carers, staff, volunteers and key external partners. Governors have a number of roles and responsibilities, including representing the wishes of their constituents to the Board, advising on the longer-term direction of the Trust, and holding the Board to account for the organisation’s performance. They play a large part in helping to ensure that the Trust acts for the benefit of the local community that it serves. To find the Governor who represents you, please see the Governor section of the website.

MCHFT also has a Youth Committee, where young people from Crewe, Nantwich and the surrounding areas are able to have their say and help to influence the decisions made at their local hospitals. Further information is available on the Youth Committee section of the website.

The Trust welcomes feedback from all sources, whether from regulators, partners, colleagues or service users. Patients are actively encouraged to provide their thoughts on their experiences at MCHFT, and can do so in a number of ways. These include direct feedback to the staff providing their care, contacting the Trust’s Customer Care Team, and the NHS Choices website (www.nhs.uk).

By working together with patients, staff and partners, MCHFT will be able to continue on its journey to providing the highest possible standards of safe care to patients.