NHS Isle of Wight Clinical Commissioning Group: Governing Body Date of Meeting: 21 March 2013 Agenda Item: 7.1 Paper number: GB13/027 RESPONSE TO THE FRANCIS REPORT Sponsor: Dr John Partridge, Clinical Director Summary of issue: Action required/ recommendation: Initial response to Francis Report. First step in a series of cultural and practical paradigm shifts. Discussion and agreement to proposed way forward. Principle risks: Reputational risks and more importantly patient safety risks increase. Other committees where this has been considered: Financial /resource implications: Legal implications/ impact: Public involvement /action taken: Equality and diversity impact: Quality and Patient Safety Committee Not quantifiable at present. High impact if seen not to be responding to Francis Report To be involved as programme of change develops. Vulnerable service users disadvantages to greater extent. Date of Paper: 21 March 2013
Isle of Wight CCG Response: The Francis Report Introduction The Francis Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry was published on 6 th February 2013. This was a report that followed the first inquiry into allegations of neglect of patients and poor care at Mid-Staffordshire Hospital. Once again the NHS has been found to have major flaws as this inquiry follows The Shipman Inquiry, the Bristol paediatric cardiac surgery inquiry and more recently the revelations of Winterbourne View (a private establishment but one in which NHS patients were cared for). This series of major inquiries suggests that the NHS has a tendency to fail the people it serves and that its alert mechanisms as to when this happens are not always in place. The recommendations made by Robert Francis are not for debate. It is for all NHS providers, commissioners and regulators to take on board. That said, the recommendations do not suggest anything surprising or new in terms of good practice, professional standards, clinical governance and principles on which the NHS is founded. As a commissioning body we have two aspects to address. The first is outward looking how do we drive quality and ensure safety from commissioned services in the future. Given that part of the problem was a target orientated style of management in Mid Staffordshire this needs careful thought as to the best way forward. The other aspect is inward looking and ensuring the right culture exists within the CCG including our own member practices, and that as a body we listen to our population. Key themes The NHS Constitution is central to many recommendations. 1. The NHS provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population. 2. Access to NHS services is based on clinical need, not an individual s ability to pay. NHS services are free of charge, except in limited circumstances sanctioned by Parliament. 3. The NHS aspires to the highest standards of excellence and professionalism in the provision of high-quality care that is safe, effective and focused on patient experience; in the planning and delivery of the clinical and other services it provides; in the people it employs and the education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population. 4. NHS services must reflect the needs and preferences of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment. 5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is an integrated system of organisations and services bound together by the principles and values now reflected in the Constitution. The NHS is committed to working jointly with local authorities NHS Isle of Wight Clinical Commissioning Group 2
and a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and well-being. 6. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves. 7. The NHS is accountable to the public, communities and patients that it serves. The NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff. The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose. Accountability To implement the changes needed in the commissioning organisation. This extends from the Governing Body and goes throughout the organisation. It also means sharing common values with providers and leading change where needed. Putting the patient first This means ensuring that the service patients receive from commissioned care is respectful, caring and safe. The challenge for commissioners is how to engage on this issue with providers and how to detect where standards slip. When problems recur time and again then commissioners need to review the level of effectiveness of organisational learning. Effective Health care Working within NICE frameworks of effective treatment and monitoring outcome and process measures. Working between regulators and providers There is a role for commissioning bodies to share information and work effectively across providers and regulators in order to help maintain fundamental standards and understand when they required enhance standards. Utilising service user and stakeholder feedback Ensuring services are tuned into patient and population requirements and observations of commissioned services is a vital part of commissioning. Linking to representative Patient Safety As commissioners the CCG needs to seek assurance that service providers have clear systems for maintenance of a safe service using national safety systems. Provider monitoring of safety incidents and resultant learning mechanisms should be open and accessible to commissioners. Where performance issues emerge on an individual basis, there needs to be clear processes for referring NHS Isle of Wight Clinical Commissioning Group 3
the professional to the appropriate manager or Responsible Officer. If more serious, the referral would be to the appropriate regulatory body. Openness Honesty and Candour Every organisation and individual is expected to be open, honest and truthful in their dealings with patients. An expectation of openness and willingness to investigate, or cooperate with an external investigation, when things go wrong, or look like they have done, is also required. Support is expected to be given to patients, relatives and associates of patients who have suffered serious harm or death. Complaints need to handled effectively and learning embedded in an organisation, with thought given to how the lessons learnt do not get forgotten over time. Commissioners may need to take an overview of how the process is handled by a provider and offer advice or guidance when necessary. Effective whistle-blowing policies together with a culture of accepting criticism, and reviewing service provision following criticism are necessary. Quality awareness GPs are in a good position to understand the standards of care that their patients receive from secondary and tertiary care. This information needs to be captured. Commissioners need clear ways of monitoring quality markers and ability to negotiate with providers effectively. Information on quality markers need to be readily available and timely so that commissioners can have early discussions when things start to go wrong. Patient feedback shortly after discharge from hospital needs to be encouraged as a way of gaining more considered and insightful information of the service provided. Acting on quality issues that arise in the commissioning cycle Commissioners are involved in setting enhanced standards. They need to integrate quality into contract monitoring and act where standards fall below that anticipated. Escalation procedures need to be in place. Commissioners need to have a public visibility so that they can engage with public where concerns are raised. Nursing Care Commissioners need to know expectations of nursing standards and gain greater clarity as to the roles and functions of healthcare support workers. Special requirements of elderly patients in hospital are required. Next steps Ownership and acceptance of these recommendations is required throughout the CCG. This will, in turn, send clear messages to provider organisations about expectations and shared cultural values. Discussion of the recommendations will embed the changes within the commissioning team. Looking at each recommendation, it is clear that the Isle of Wight is in a positive place with regard to having established systems and common values around openness with regard to quality and patient safety. There are, however, areas that will need strengthening and it will be important for the CCG and the main Island provider to examine their relationship to ensure that, if necessary, CCG can be effectively critical. The CCG also needs to take a comprehensive approach to the services it commissions and does not simply concentrate on the Isle of Wight NHS Trust. NHS Isle of Wight Clinical Commissioning Group 4
The Francis report is a large document and has been criticised for being so detailed. The effect can be overwhelming so an approach that reduces the whole into constituent parts will be helpful. We propose developing a simple self-assessment tool that initially will assess strengths and weakness within the CCG and in our interaction with the provider(s). Using this tool will familiarise commissioners, executives and Governing Body members with relevant quality and patient safety recommendations from Francis, and allow the CCG to focus on the more important issues first. John Partridge Clinical Director Isle of Wight CCG 07.03.2013 NHS Isle of Wight Clinical Commissioning Group 5