Meeting: Trust Board Public Meeting Date: 29 October 2014 Title of Paper: Francis 2 Summary Update Report Key Issues: (Actions, Timescales, Costs etc.) The second Francis report (Francis 2), published in 2013, into the deaths at Mid Staffordshire Hospitals NHS Foundation Trust found considerable failures of local NHS organisations and providers to work together when failures in the quality of care at the Trust were known in the local area. In total the report made 290 recommendations for improvement spanning commissioners, providers, regulatory and other organisations affiliated with NHS healthcare. All Trusts were required to undertake an internal check in line with the recommendations of the Francis report to determine areas where further improvements could be made. This report is an update on our progress. The Trust focused on the key recommendations to create a cultural shift in line with the recommendations in the report. The recent Care Quality Commission report into the Trust recognised the commitment of Trust staff and the care they provided to patients, but we should not be complacent as there are considerable challenges eg waiting times that need to be addressed on a sustainable level in order to ensure we continue to meet the standards laid out in Francis 2. There is assurance that much of what we do is positive and of high quality; internally the CQC report has identified areas where we can make further positive impact for patients and how we can strengthen this externally by working together with partners, rather than apart, which was a key lesson from the Francis reports. The lessons from the two Francis reports into Mid Staffordshire hit home hard and the Trust has set high standards for candour and for patient complaints in response to this. The new Trust Quality & Safety Strategy will be the main driver for taking this work forward and ensuring that our response to Francis is embedded in our governance systems and our day to day service delivery. The next update to the Board will be presented in January 2015. Links to Strategic Objectives: Provide services that are safe, person centred, delivered in appropriate environments and sensitive to the needs of the individual Retain the confidence of patients, carers and commissioners by upholding the principles of the NHS Risk Issues: (Financial, Clinical, Governance etc) None Recommendations: The Board is asked to accept the summary update to the Francis 2 recommendations
Author of Report: Jules Williams, Care Quality & Compliance Director 2
Humber NHS Foundation Trust FRANCIS 2 SUMMARY UPDATE REPORT October 2014 3
A reminder The experience of many previous inquiries is that, following the initial courtesy of a welcome and an indication that its recommendations will be accepted or viewed favourably, progress in implementation becomes slow or non-existent. It is respectfully suggested that the subject matter of this Inquiry is too important for it be allowed to suffer a similar fate. What is required is a means by which it is clear not only which of the recommendations has been accepted, by whom, and what progress is being made with implementation, but above all how the spirit behind the recommendations is being applied. All organisations that are or should be involved in implementation should account for their decisions and actions in this regard. - Robert Francis Q.C. - Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry 4
1. Introduction - The Challenge The second Francis report (Francis 2), published in 2013, into the deaths at Mid Staffordshire Hospitals NHS Foundation Trust found considerable failures of local NHS organisations and providers to work together when failures in the quality of care at the Trust were known in the local area. In total the report made 290 recommendations for improvement spanning commissioners, providers, regulatory and other organisations affiliated with NHS healthcare. The Trust recognised the requirement to focus on key recommendations to create a cultural shift in line with the recommendations in the report. The recent Care Quality Commission report into the Trust recognised the commitment of Trust staff and the care they provided to patients, but we should not be complacent as there are considerable challenges eg waiting times that need to be addressed on a sustainable level in order to ensure we continue to meet the standards laid out in Francis 2. 2. The Work So Far During September 2013 the Medical Director led an internal check in line with the recommendations of the first Francis Report to determine areas where further improvements could be made. This work highlighted where learning from Francis would strengthen our systems and processes and embed the essence of the report in our organisation to ensure that the needs of patients, carers and users of services are at the heart of our day to day business. As well as this individual work the Trust is a key member of the local health economy wide Stakeholder Board led by the Commissioners. The Stakeholder Board does not look to duplicate or replace the work already being done by the Trust to meet Francis 2 recommendations. Its aim was to identify where the partner organisations had common goals and develop a joint approach to making progress against these goals to lead to the best possible results for local people. Through this work it is clear that there is already evidence of good practice across Hull and the East Riding and the Stakeholder Board has been a valuable opportunity to share and celebrate this and to learn from one another. All partners shared a commitment to continuing and developing this approach because it was the right thing to do and not just as a result of the Francis Report and its recommendations. As a Trust and a wider stakeholder group our work has been focused on three key areas. The Duty of Candour (Being open and honest when things go wrong) NHS Complaints The role of staff in patient experience 5
3. Key Work to date 3.1 Duty of Candour Focus To ensure we are open and honest with patients/carers, the public and with each other when things go wrong with the aim of looking at how this could be applied within and between organisations. Actions taken Current practice around Duty of Candour from national publications and professional standards was reviewed to understand current requirements. Conflicts or contradictions in guidance were identified and an approach was agreed. The group considered what a local Duty of Candour would look like. Key results Whilst recognising that being open and honest with patients is something that occurs every day across the Trust, we needed to ensure we had in place a system for reporting on duty of candour as part of the incident reporting system, and how we learn from those incidents. The first we have completed as we have integrated the duty of candour into incident reporting, the second represents more of a challenge and will form a key part of the review and development of governance systems ward to Board. Across the patch a draft Duty of Candour protocol between local providers of NHS services and commissioners has been developed. The protocol reflects best practice and builds in local practice that the organisations in Hull and East Riding determine to be in the best interest of patients. We have also undertaken the following pieces of work: Informed consent a duty of candour applies when explaining risks and treatment with patients, consent forms under revision to be in place by December 2014. Partnership working processes are in place to share a duty of candour issues between organisations, taking full account of information governance requirements Public information we will publish what we have done about making our services safer via our website from December 2014. Professional registration, legal and regulatory requirements are in place. 6
3.2 NHS Complaints Focus To review current complaints handling both within the Trust and across organisations, share best practice and agree best practice principles for investigating and learning from complaints. Actions taken A review taking into account the recommendations within the Clwyd Hart report (2013) into patient complaints was conducted to inform the development of a set of patient-focused pledges for complaints across commissioners and providers, which the Trust has signed up to. Key results Pledges are: Bring together of Complaints, PSALS and patient experience under a single management structure (Care Quality & Compliance Director), this was completed in July 2014. Implementation the Patient Voice Volunteer pilot across inpatient services. The volunteers will work as PALs support officers across the services, thus providing an opportunity for early resolution of issues. Volunteers have been recruited and induction will take place in December 2014. Agreement to work to an agreed framework for more joined-up working and simplify complaints Investigations that involve multiple organisations. This is underway with the stakeholder Board. Identified ways in which the learning and patient experience elements of the complaints process can be better utilised and evidenced to the Board, Governors and the wider public. The revised quarterly report will be submitted the November Board. Promote the rights of patients as outlined in the NHS Constitution, this will go live on the Trust website in December 2014. To promote early discussion and resolution between patients and services as an alternative to more formal complaints processes 3.3 Staff role in Experience Focus To review the role that staff play in creating a positive patient experience and exploring how this can be further supported and strengthened. A good example of this is values-based recruitment ie recruiting staff whose values reflect those of a caring organisation Actions taken Best practice tools, methodologies and approaches to capturing and learning from patient experience have been reviewed and these will form part of a new focus on patient experience from January 2015. 7
Tools and approaches that exist to improve staff skills around patient experience have also been mapped to support the above. The author will work with the Director of Human Resources and Diversity to further develop this work as part of the organisational development strategy. As part of the new integrated audit and governance system for the Trust we will have a separate patient experience group, chaired by a Non Executive Director ensure a high profile across the Trust. Key results Successful implementation of the friends and family system for patients and staff. 4. Patient & Public Event `Putting Patients First` We need to embrace transparency and learning, unequivocally and everywhere, so as to build trust with the public and knowledge within the NHS. We need to embed compassion in every part of the NHS, placing patients wellbeing at the centre of every decision we make. And we need to involve patients, their families and carers as much as possible in that process. Jane Cummings, Chief Nursing Officer for England The public event that took place on the July 16 th 2014 aimed to take forward the recommendations and direction of travel with public involvement as described by Jane Cummings above. The Putting Patients First event gave us a public perspective and feedback on the above and has enables us to develop meaningful action plans eg patient voice volunteers at an organisational level and across Hull and East Riding which we will continue to develop as part of the Francis 2 Board going forward. 5. Summary There is assurance that much of what we do is positive and of high quality; internally the CQC report has identified areas where we can make further positive impact for patients and how we can strengthen this externally by working together with partners, rather than apart, which was a key lesson from the Francis reports. The lessons from the two Francis reports into Mid Staffordshire hit home hard and the Trust has set high standards for candour and for patient complaints in response to this. The new Trust Quality & Safety Strategy will be the main driver for taking this work forward and ensuring that our response to Francis is embedded in our governance systems and our day to day service delivery. The next update to the Board will be presented in January 2015. Jules Williams Care Quality & Compliance Director October 2014 8