Teamwork
There needs to be effective teamwork between all the different disciplines and services that together provide the collective care often required by an elderly patient; the contribution of cleaners, maintenance staff, and catering staff also needs to be recognised and valued.
- The NHS Patient Safety Strategy (July 2019) identifies safety culture as a key foundation, calling for a "just culture" approach and a systems and human factors approach. It promotes multidisciplinary teamwork and open communication as essential to patient safety (NHS England, NHS Patient Safety Strategy, July 2019).
- Safety huddles — daily, focused frontline team discussions of specific patient safety concerns lasting 5-15 minutes — have been spread across the NHS. The Health Foundation-funded HUSH (Huddle Up for Safer Healthcare) project scaled safety huddles across 136 wards in three NHS trusts, with over 70% of wards successfully embedding the practice and pooled results showing significant reduction in falls (Health Foundation, HUSH).
- SBAR (Situation-Background-Assessment-Recommendation), a structured clinical communication tool originating from TeamSTEPPS, is widely used across NHS nursing and medical practice for handovers and escalation of concerns, promoting effective communication between disciplines (NHS AQUA, SBAR Communication Tool).
- The RCP "Modern Ward Rounds" guidance (June 2021), published jointly with the RCN, Royal Pharmaceutical Society, Chartered Society of Physiotherapy, and NHS England, emphasises multidisciplinary inpatient review and provides self-assessment tools for effective ward round teamwork (Royal College of Physicians, Modern Ward Rounds, June 2021).
- While these initiatives promote effective teamwork, there is no single national standard mandating multidisciplinary teamwork at ward level; implementation and culture vary by trust.
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.