Recording of routine observations
The recording of routine observations on the ward should, where possible, be done automatically as they are taken, with results being immediately accessible to all staff electronically in a form enabling progress to be monitored and interpreted. If this cannot be done, there needs to be a system whereby ward leaders and named nurses are responsible for ensuring that the observations are carried out and recorded.
- The National Early Warning Score 2 (NEWS2) was published by the Royal College of Physicians in December 2017, updating the original NEWS (2012). A joint Patient Safety Alert from NHS Improvement, the RCP, and NHS England (April 2018) set a deadline for full adoption of NEWS2 across all acute and ambulance trusts by 31 March 2019. NEWS2 provides the standardised clinical scoring system for routine observations that automated systems are built to calculate (RCP, NEWS2, December 2017; NHS England Patient Safety Alert, April 2018).
- The government's 2022 Plan for Digital Health and Social Care set a target for 90% of NHS trusts to have electronic patient records (EPRs) by December 2023, and all trusts by March 2025. NHS England announced in November 2023 that 90% of trusts were using EPRs. However, only 25% were fully electronic; 71% used mixed paper and electronic systems. Nearly £2 billion in funding has been allocated to support EPR implementation (A Plan for Digital Health and Social Care, DHSC, June 2022).
- Electronic observations systems that automatically record vital signs at the bedside and calculate NEWS2 scores are increasingly adopted but not yet universal. Specific data on the proportion of trusts using electronic bedside observations as distinct from broader EPR is not centrally published.
- Francis's fallback recommendation — that ward leaders and named nurses should be responsible for ensuring observations are carried out and recorded — is addressed through the named nurse policies and CQC's assessment of observation recording practices under its safe key question.
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.
Francis recommended recording of routine observations (vital signs, fluid balance, nutrition). Electronic observation systems have been deployed in many trusts. The National Early Warning Score (NEWS2) is now standard. However, digital maturity varies significantly across trusts and paper-based recording persists in some settings.
View detailed findings
Electronic observation recording has improved significantly through NEWS2 and digital systems but implementation is inconsistent across the NHS.
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.
Monitor merged with the Trust Development Authority to form NHS Improvement from 1 April 2016. NHS Improvement then merged with NHS England from 1 July 2022 under Health and Care Act 2022. Francis recommended incremental merger of system regulatory functions between Monitor and CQC; this was partially achieved through structural reorganisation.
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.