Public Inquiry Recommendations

F151 Accepted in Part

Mid Staffs Inquiry (2013)

Complaints to MPs

MPs are advised to consider adopting some simple system for identifying trends in the complaints and information they received from constituents. They should also consider whether individual complaints imply concerns …

- The government's response to the Francis Report in "Hard Truths" (Cm 8777, November 2013) noted that MPs have a significant role in representing the …

F152 Accepted

Mid Staffs Inquiry (2013)

Medical training

Any organisation which in the course of a review, inspection or other performance of its duties, identifies concerns potentially relevant to the acceptability of training provided by a healthcare provider, …

- The Health and Social Care Act 2012 (section 96) placed a statutory duty on specified bodies — including CQC, NHS England (then the NHS …

F153 Accepted in Part

Mid Staffs Inquiry (2013)

Medical training

The Secretary of State should by statutory instrument specify all medical education and training regulators as relevant bodies for the purpose of their statutory duty to cooperate. Information sharing between …

- The Health and Social Care Act 2012 (section 96) placed a statutory duty to cooperate on CQC, NHS England, Monitor, and HEE. The Secretary …

F154 Accepted

Mid Staffs Inquiry (2013)

Medical training

The Care Quality Commission and Monitor should develop practices and procedures with training regulators and bodies responsible for the commissioning and oversight of medical training to coordinate their oversight of …

- CQC and the GMC operate a memorandum of understanding governing information sharing and coordination of oversight of healthcare organisations that provide medical education and …

F155 Accepted

Mid Staffs Inquiry (2013)

Medical training

The General Medical Council should set out a standard requirement for routine visits to each local education provider, and programme in accordance with the following principles: The Postgraduate Dean should …

- The GMC published "Promoting Excellence: Standards for Medical Education and Training" in 2015, replacing "Tomorrow's Doctors" (2009) and "The Trainee Doctor" (2011). The standards …

F156 Accepted

Mid Staffs Inquiry (2013)

Medical training

The system for approving and accrediting training placement providers and programmes should be configured to apply the principles set out above.

- The GMC's "Promoting Excellence: Standards for Medical Education and Training" (2015) sets out the standards for the approval and accreditation of medical education and …

F157 Accepted

Mid Staffs Inquiry (2013)

Matters to be reported to the General Medical Council

The General Medical Council should set out a clear statement of what matters; deaneries are required to report to the General Medical Council either routinely or as they arise. Reports …

- The GMC's "Promoting Excellence: Standards for Medical Education and Training" (2015) includes requirements for designated bodies (employers of doctors) and postgraduate deans to report …

F158 Accepted

Mid Staffs Inquiry (2013)

Training and training establishments as a source of safety information

The General Medical Council should amend its standards for undergraduate medical education to include a requirement that providers actively seek feedback from students and tutors on compliance by placement providers …

- The GMC published "Promoting Excellence: Standards for Medical Education and Training" in 2015, which includes specific requirements for medical schools to actively seek and …

F159 Accepted

Mid Staffs Inquiry (2013)

Training and training establishments as a source of safety information

Surveys of medical students and trainees should be developed to optimise them as a source of feedback of perceptions of the standards of care provided to patients. The General Medical …

- The GMC's National Training Survey (NTS) is conducted annually and collects data from all doctors in training in the UK. The NTS includes questions …

F160 Accepted

Mid Staffs Inquiry (2013)

Training and training establishments as a source of safety information

Proactive steps need to be taken to encourage openness on the part of trainees and to protect them from any adverse consequences in relation to raising concerns.

- The Freedom to Speak Up Review (Sir Robert Francis QC, February 2015) made 20 recommendations for creating a culture of openness in the NHS, …

F161 Accepted

Mid Staffs Inquiry (2013)

Training and training establishments as a source of safety information

Training visits should make an important contribution to the protection of patients: Obtaining information directly from trainees should remain a valuable source of information – but it should not be …

- The GMC's "Promoting Excellence: Standards for Medical Education and Training" (2015) sets out requirements for quality assurance visits to training environments, including direct observation …

F162 Accepted

Mid Staffs Inquiry (2013)

Training and training establishments as a source of safety information

The General Medical Council should in the course of its review of its standards and regulatory process ensure that the system of medical training and education maintains as its first …

- The GMC published "Promoting Excellence: Standards for Medical Education and Training" in 2015, following a comprehensive review of its education and training standards. The …

F163 Accepted

Mid Staffs Inquiry (2013)

Safe staff numbers and skills

The General Medical Council's system of reviewing the acceptability of the provision of training by healthcare providers must include a review of the sufficiency of the numbers and skills of …

- The GMC's "Promoting Excellence: Standards for Medical Education and Training" (2015) includes requirements that education and training providers must have sufficient numbers of appropriately …

F164 Accepted in Part

Mid Staffs Inquiry (2013)

Approved Practice Settings

The Department of Health and the General Medical Council should review whether the resources available for regulating Approved Practice Setting are adequate and, if not, make arrangements for the provision …

- The GMC's approved practice settings scheme enables doctors working outside NHS trusts (for example, in locum agencies, private practice, or non-NHS organisations) to satisfy …

F165 Accepted in Part

Mid Staffs Inquiry (2013)

Approved Practice Settings

The General Medical Council should immediately review its approved practice settings criteria with a view to recognition of the priority to be given to protecting patients and the public.

- The GMC reviewed and updated its approved practice settings criteria following the Francis Report. The Medical Act 1983 (section 29A, inserted by the Health …

F166 Accepted in Part

Mid Staffs Inquiry (2013)

Approved Practice Settings

The General Medical Council should in consultation with patient interest groups and the public immediately review its procedures for assuring compliance with its approved practice settings criteria with a view …

- The GMC's quality assurance framework for approved practice settings includes active information sharing with CQC and other healthcare regulators. The statutory duty to cooperate …

F167 Accepted in Part

Mid Staffs Inquiry (2013)

Approved Practice Settings

The Department of Health and the General Medical Council should review the powers available to the General Medical Council in support of assessment and monitoring of approved practice settings establishments …

- The GMC has powers under the Medical Act 1983 to set standards for medical education and training and to conduct quality assurance visits to …

F168 Accepted in Part

Mid Staffs Inquiry (2013)

Approved Practice Settings

The Department of Health and the General Medical Council should consider making the necessary statutory (and regulatory changes) to incorporate the approved practice settings scheme into the regulatory framework for …

- The Medical Act 1983 provides the statutory framework for the regulation of medical education and training by the GMC, including the approval of training …

F169 Accepted in Part

Mid Staffs Inquiry (2013)

Role of the Department of Health and the National Quality Board

The Department of Health, through the National Quality Board, should ensure that procedures are put in place for facilitating the identification of patient safety issues by training regulators and cooperation …

- The National Quality Board (NQB), established as a multi-stakeholder body bringing together NHS England, CQC, NICE, GMC, HSSIB, and other system leaders, provides a …

F170 Accepted

Mid Staffs Inquiry (2013)

Health Education England

Health Education England should have a medically qualified director of medical education and a lay patient representative on its board.

- Health Education England (HEE) was established as a non-departmental public body in June 2012 (as a special health authority) and given statutory footing under …

F171 Accepted

Mid Staffs Inquiry (2013)

Deans

All Local Education and Training Boards should have a post of medically qualified postgraduate dean responsible for all aspects of postgraduate medical education.

- Health Education England established Local Education and Training Boards (LETBs) across England, each with a medically qualified postgraduate dean responsible for all aspects of …

F172 Accepted

Mid Staffs Inquiry (2013)

Proficiency in the English language

The Government should consider urgently the introduction of a common requirement of proficiency in communication in the English language with patients and other persons providing healthcare to the standard required …

- The Medical Act 1983 was amended by the Health Care and Associated Professions (Knowledge of English) Order 2014 (SI 2014/1887) and by the Health …

F173 Accepted

Mid Staffs Inquiry (2013)

Principles of openness transparency and candour

Every healthcare organisation and everyone working for them must be honest, open and truthful in all their dealings with patients and the public, and organisational and personal interests must never …

- The statutory duty of candour was enacted as Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It came …

F174 Accepted

Mid Staffs Inquiry (2013)

Candour about harm

Where death or serious harm has been or may have been caused to a patient by an act or omission of the organisation or its staff, the patient (or any …

- Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 imposes a specific obligation on registered providers to notify patients …

F175 Accepted

Mid Staffs Inquiry (2013)

Candour about harm

Full and truthful answers must be given to any question reasonably asked about his or her past or intended treatment by a patient (or, if deceased, to any lawfully entitled …

- Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires registered providers to be open and transparent with patients …

F176 Accepted

Mid Staffs Inquiry (2013)

Openness with regulators

Any statement made to a regulator or a commissioner in the course of its statutory duties must be completely truthful and not misleading by omission.

- Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 applies the duty of candour to registered providers in their …

F177 Accepted

Mid Staffs Inquiry (2013)

Openness in public statements

Any public statement made by a healthcare organisation about its performance must be truthful and not misleading by omission.

- Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires registered providers to act in an open and transparent …

F178 Accepted in Part

Mid Staffs Inquiry (2013)

Implementation of the duty Ensuring consistency of obligations under the duty of openness transparency and candour

The NHS Constitution should be revised to reflect the changes recommended with regard to a duty of openness, transparency and candour, and all organisations should review their contracts of employment, …

- The NHS Constitution was updated in July 2015 to incorporate the principles of openness, transparency, and candour recommended by Francis. The Constitution includes a …

F179 Accepted

Mid Staffs Inquiry (2013)

Restrictive contractual clauses

"Gagging clauses" or non disparagement clauses should be prohibited in the policies and contracts of all healthcare organisations, regulators and commissioners; insofar as they seek, or appear, to limit bona …

- The Freedom to Speak Up Review (Sir Robert Francis QC, February 2015) specifically addressed the use of gagging clauses in NHS contracts and settlement …

F180 Accepted

Mid Staffs Inquiry (2013)

Candour about incidents

Guidance and policies should be reviewed to ensure that they will lead to compliance with Being Open, the guidance published by the National Patient Safety Agency.

- The National Patient Safety Agency's "Being Open" guidance (2009) was superseded by the statutory duty of candour under Regulation 20 of the Health and …

F181 Accepted in Part

Mid Staffs Inquiry (2013)

Enforcement of the duty Statutory duties of candour in relation to harm to patients

A statutory obligation should be imposed to observe a duty of candour: On healthcare providers who believe or suspect that treatment or care provided by it to a patient has …

- The statutory duty of candour on healthcare providers was enacted as Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations …

F182 Accepted

Mid Staffs Inquiry (2013)

Statutory duty of openness and transparency

There should be a statutory duty on all directors of healthcare organisations to be truthful in any information given to a healthcare regulator or commissioner, either personally or on behalf …

- The Fit and Proper Person Requirement (Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014) requires directors of registered …

F183 Not Accepted

Mid Staffs Inquiry (2013)

Criminal liability

It should be made a criminal offence for any registered medical practitioner, or nurse, or allied health professional or director of an authorised or registered healthcare organisation: Knowingly to obstruct …

- The Criminal Justice and Courts Act 2015 (sections 20-21), which received Royal Assent on 12 February 2015, created two new criminal offences directly relevant …

F184 Accepted

Mid Staffs Inquiry (2013)

Enforcement by the Care Quality Commission

Observance of the duty should be policed by the Care Quality Commission, which should have powers in the last resort to prosecute in cases of serial non-compliance or serious and …

- CQC has statutory responsibility for monitoring and enforcing compliance with the duty of candour under Regulation 20 of the Health and Social Care Act …

F185 Accepted

Mid Staffs Inquiry (2013)

Focus on culture of caring

There should be an increased focus in nurse training, education and professional development on the practical requirements of delivering compassionate care in addition to the theory. A system which ensures …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and committed to strengthening values-based recruitment and training across the NHS …

F186 Accepted

Mid Staffs Inquiry (2013)

Practical hands-on training and experience

Nursing training should be reviewed so that sufficient practical elements are incorporated to ensure that a consistent standard is achieved by all trainees throughout the country. This requires national standards.

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and committed to reviewing nursing training to incorporate sufficient practical elements …

F187 Accepted

Mid Staffs Inquiry (2013)

Practical hands-on training and experience

There should be a national entry-level requirement that student nurses spend a minimum period of time, at least three months, working on the direct care of patients under the supervision …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation in principle and committed to ensuring nursing students gain sufficient direct …

F188 Accepted in Part

Mid Staffs Inquiry (2013)

Aptitude test for compassion and caring

The Nursing and Midwifery Council, working with universities, should consider the introduction of an aptitude test to be undertaken by aspirant registered nurses at entry into the profession, exploring, in …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and stated that HEE would work with the NMC and universities …

F189 Accepted in Part

Mid Staffs Inquiry (2013)

Consistent training

The Nursing and Midwifery Council and other professional and academic bodies should work towards a common qualification assessment/examination.

- The government's response in "Hard Truths" (Cm 8777, November 2013) noted this recommendation and stated that it would work with the NMC and other …

F190 Accepted in Part

Mid Staffs Inquiry (2013)

National standards

There should be national training standards for qualification as a registered nurse to ensure that newly qualified nurses are competent to deliver a consistent standard of the fundamental aspects of …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and committed to establishing national training standards for nurses (Hard Truths: …

F191 Accepted

Mid Staffs Inquiry (2013)

Recruitment for values and commitment

Healthcare employers recruiting nursing staff, whether qualified or unqualified, should assess candidates' values, attitudes and behaviours towards the well-being of patients and their basic care needs, and care providers should …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and committed to ensuring values-based recruitment was adopted across the NHS …

F192 Accepted in Part

Mid Staffs Inquiry (2013)

Strong nursing voice

The Department of Health and Nursing and Midwifery Council should introduce the concept of a Responsible Officer for nursing, appointed by and accountable to, the Nursing and Midwifery Council.

- The government's response in "Hard Truths" (Cm 8777, November 2013) did not accept the specific proposal for a "Responsible Officer" for nursing equivalent to …

F193 Accepted in Part

Mid Staffs Inquiry (2013)

Standards for appraisal and support

Without introducing a revalidation scheme immediately, the Nursing and Midwifery Council should introduce common minimum standards for appraisal and support with which responsible officers would be obliged to comply. They …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted the principle of this recommendation and stated that the NMC would develop a …

F194 Accepted in Part

Mid Staffs Inquiry (2013)

Standards for appraisal and support

As part of a mandatory annual performance appraisal, each Nurse, regardless of workplace setting, should be required to demonstrate in their annual learning portfolio an up-to-date knowledge of nursing practice …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and stated that the NMC revalidation model would incorporate annual appraisal …

F195 Accepted in Part

Mid Staffs Inquiry (2013)

Nurse leadership

Ward nurse managers should operate in a supervisory capacity, and not be office-bound or expected to double up, except in emergencies as part of the nursing provision on the ward. …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and stated that ward managers should be supervisory leaders, visible and …

F196 Accepted

Mid Staffs Inquiry (2013)

Nurse leadership

The Knowledge and Skills Framework should be reviewed with a view to giving explicit recognition to nurses' demonstrations of commitment to patient care and, in particular, to the priority to …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and stated that the NHS Knowledge and Skills Framework would be …

F197 Accepted in Part

Mid Staffs Inquiry (2013)

Nurse leadership

Training and continuing professional development for nurses should include leadership training at every level from student to director. A resource for nurse leadership training should be made available for all …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and committed to making leadership training available at all levels of …

F198 Accepted

Mid Staffs Inquiry (2013)

Measuring cultural health

Healthcare providers should be encouraged by incentives to develop and deploy reliable and transparent measures of the cultural health of front-line nursing workplaces and teams, which build on the experience …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and stated that healthcare providers should develop transparent measures of cultural …

F199 Accepted

Mid Staffs Inquiry (2013)

Key nurses

Each patient should be allocated for each shift a named key nurse responsible for coordinating the provision of the care needs for each allocated patient. The named key nurse on …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and committed to ensuring every hospital patient has a named nurse …

F200 Accepted in Part

Mid Staffs Inquiry (2013)

Key nurses

Consideration should be given to the creation of a status of Registered Older Person's Nurse.

- The government's response in "Hard Truths" (Cm 8777, November 2013) stated that it would ask Health Education England and the NMC to consider whether …