Communication with and about patients
Regular interaction and engagement between nurses and patients and those close to them should be systematised through regular ward rounds: All staff need to be enabled to interact constructively, in a helpful and friendly fashion, with patients and visitors. Where possible, wards should have areas where more mobile patients and their visitors can meet in relative privacy and comfort without disturbing other patients. The NHS should develop a greater willingness to communicate by email with relatives. The currently common practice of summary discharge letters followed up some time later with more substantive ones should be reconsidered. Information about an older patient's condition, progress and care and discharge plans should be available and shared with that patient and, where appropriate, those close to them, who must be included in the therapeutic partnership to which all patients are entitled.
- The Seven Day Services Clinical Standards (first published 2015, updated February 2022) set national expectations for ward rounds: Standard 2 requires all emergency admissions to be seen by a suitable consultant within 14 hours of arrival; Standard 8 requires twice-daily consultant review in acute medical units, surgical assessment units, and ICUs, and at least once every 24 hours on general wards, seven days a week (NHS England, Seven Day Services Clinical Standards, February 2022).
- The Royal College of Physicians published "Modern Ward Rounds: Good Practice for Multidisciplinary Inpatient Review" in June 2021, jointly with the RCN, Royal Pharmaceutical Society, Chartered Society of Physiotherapy, and NHS England. The guidance addresses multidisciplinary review, communication with patients and families, and provides self-assessment tools for ward round quality (RCP, Modern Ward Rounds, June 2021).
- Francis's recommendation also addressed communication with patients and families, including email communication and discharge information. The NHS Standard Contract and CQC inspection framework both require providers to share care plans and discharge information with patients. The NHS App (launched December 2018) provides patients with electronic access to their medical records, appointment information, and GP correspondence.
- The recommendation that discharge letters should be timely and substantive is addressed by the Professional Record Standards Body (PRSB) discharge summary standard, adopted across NHS trusts, requiring structured discharge summaries sent to GPs within 24 hours.
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.
NMC Revalidation launched 1 April 2016 in direct response to Francis Report. All nurses and midwives must revalidate every three years. Replaced the Post-Registration Education and Practice system. Updated NMC Code published March 2015 strengthened requirements around candour and raising concerns.
NMC published updated Code of Professional Standards for nurses and midwives (March 2015). Standard 14 specifically requires nurses and midwives to be open and candid with all service users about all aspects of care, including when mistakes or harm have occurred.
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.