Public Inquiry Recommendations

F201 Accepted

Mid Staffs Inquiry (2013)

Strengthening the nursing professional voice

The Royal College of Nursing should consider whether it should formally divide its "Royal College" functions and its employee representative/trade union functions between two bodies rather than behind internal "Chinese …

- The government's response in "Hard Truths" (Cm 8777, November 2013) noted that this recommendation was addressed to the Royal College of Nursing and stated …

F202 Accepted

Mid Staffs Inquiry (2013)

Strengthening the nursing professional voice

Recognition of the importance of nursing representation at provider level should be given by ensuring that adequate time is allowed for staff to undertake this role, and employers and unions …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and stated that adequate time for staff representation at provider level …

F203 Accepted

Mid Staffs Inquiry (2013)

Strengthening the nursing professional voice

A forum for all directors of nursing from both NHS and independent sector organisations should be formed to provide a means of coordinating the leadership of the nursing profession.

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and stated that a forum for directors of nursing from NHS …

F204 Accepted in Part

Mid Staffs Inquiry (2013)

Strengthening the nursing professional voice

All healthcare providers and commissioning organisations should be required to have at least one executive director who is a registered nurse, and should be encouraged to consider recruiting nurses as …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and stated that all healthcare provider organisations should have at least …

F205 Accepted in Part

Mid Staffs Inquiry (2013)

Strengthening the nursing professional voice

Commissioning arrangements should require the boards of provider organisations to seek and record the advice of its nursing director on the impact on the quality of care and patient safety …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and stated that boards should seek and record the advice of …

F206 Accepted

Mid Staffs Inquiry (2013)

Strengthening the nursing professional voice

The effectiveness of the newly positioned office of Chief Nursing Officer should be kept under review to ensure the maintenance of a recognised leading representative of the nursing profession as …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and stated that the effectiveness of the Chief Nursing Officer role …

F207 Accepted in Part

Mid Staffs Inquiry (2013)

Strengthening identification of healthcare support workers and nurses

There should be a uniform description of healthcare support workers, with the relationship with currently registered nurses made clear by the title.

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation in principle, noting the importance of clear identification of healthcare support …

F208 Accepted in Part

Mid Staffs Inquiry (2013)

Strengthening identification of healthcare support workers and nurses

Commissioning arrangements should require provider organisations to ensure by means of identity labels and uniforms that a healthcare support worker is easily distinguishable from that of a registered nurse.

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation in principle, agreeing that healthcare support workers should be visually distinguishable …

F209 Not Accepted

Mid Staffs Inquiry (2013)

Registration of healthcare support workers

A registration system should be created under which no unregistered person should be permitted to provide for reward direct physical care to patients currently under the care and treatment of …

- The government explicitly rejected this recommendation in "Hard Truths" Volume 2 (Cm 8777, November 2013), one of only nine Francis recommendations not accepted. The …

F210 Accepted

Mid Staffs Inquiry (2013)

Code of conduct for healthcare support workers

There should be a national code of conduct for healthcare support workers.

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and acted on it prior to publication of the full response …

F211 Accepted

Mid Staffs Inquiry (2013)

Training standards for healthcare support workers

There should be a common set of national standards for the education and training of healthcare support workers.

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F212 Not Accepted

Mid Staffs Inquiry (2013)

Training standards for healthcare support workers

The code of conduct, education and training standards and requirements for registration for healthcare support workers should be prepared and maintained by the Nursing and Midwifery Council after due consultation …

- The government's response in "Hard Truths" (Cm 8777, November 2013) rejected this recommendation, as a consequence of rejecting F209 (statutory registration of healthcare support …

F213 Not Accepted

Mid Staffs Inquiry (2013)

Training standards for healthcare support workers

Until such time as the Nursing and Midwifery Council is charged with the recommended regulatory responsibilities, the Department of Health should institute a nationwide system to protect patients and care …

- The government's response in "Hard Truths" (Cm 8777, November 2013) rejected this recommendation, stating that existing safeguards — particularly the Disclosure and Barring Service …

F214 Accepted

Mid Staffs Inquiry (2013)

Shared training

A leadership staff college or training system, whether centralised or regional, should be created to: provide common professional training in management and leadership to potential senior staff; promote healthcare leadership …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F215 Accepted

Mid Staffs Inquiry (2013)

Shared code of ethics

A common code of ethics, standards and conduct for senior board-level healthcare leaders and managers should be produced and steps taken to oblige all such staff to comply with the …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F216 Accepted

Mid Staffs Inquiry (2013)

Leadership framework

The leadership framework should be improved by increasing the emphasis given to patient safety in the thinking of all in the health service. This could be done by, for example, …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F217 Accepted in Part

Mid Staffs Inquiry (2013)

Common selection criteria

A list should be drawn up of all the qualities generally considered necessary for a good and effective leader. This in turn could inform a list of competences a leader …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F218 Accepted

Mid Staffs Inquiry (2013)

Enforcement of standards and accountability

Serious non-compliance with the code, and in particular, non-compliance leading to actual or potential harm to patients, should render board-level leaders and managers liable to be found not to be …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation and introduced the Fit and Proper Person Test (FPPT) as CQC …

F219 Accepted in Part

Mid Staffs Inquiry (2013)

A regulator as an alternative

An alternative option to enforcing compliance with a management code of conduct, with the risk of disqualification, would be to set up an independent professional regulator. The need for this …

- The government's response in "Hard Truths" (Cm 8777, November 2013) noted this recommendation as an alternative to F218 and indicated it would proceed with …

F220 Accepted in Part

Mid Staffs Inquiry (2013)

Accreditation

A training facility could provide the route through which an accreditation scheme could be organised. Although this might be a voluntary scheme, at least initally, the objective should be to …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation in principle (Hard Truths: the Journey to Putting Patients First, DHSC, …

F221 Accepted

Mid Staffs Inquiry (2013)

Ensuring common standards of competence and compliance

Consideration should be given to ensuring that there is regulatory oversight of the competence and compliance with appropriate standards by the boards of health service bodies which are not foundation …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F222 Accepted

Mid Staffs Inquiry (2013)

General Medical Council Systemic investigation where needed

The General Medical Council should have a clear policy about the circumstances in which a generic complaint or report ought to be made to it, enabling a more proactive approach …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F223 Accepted in Part

Mid Staffs Inquiry (2013)

Enhanced resources

If the General Medical Council is to be effective in looking into generic complaints and information it will probably need either greater resources, or better cooperation with the Care Quality …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F224 Accepted

Mid Staffs Inquiry (2013)

Information sharing

Steps must be taken to systematise the exchange of information between the Royal Colleges and the General Medical Council, and to issue guidance for use by employers of doctors to …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F225 Accepted

Mid Staffs Inquiry (2013)

Peer reviews

The General Medical Council should have regard to the possibility of commissioning peer reviews pursuant to section 35 of the Medical Act 1983 where concerns are raised in a generic …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F226 Accepted in Part

Mid Staffs Inquiry (2013)

Nursing and Midwifery Council Investigation of systemic concerns

To act as an effective regulator of nurse managers and leaders, as well as more front-line nurses, the Nursing and Midwifery Council needs to be equipped to look at systemic …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F227 Accepted in Part

Mid Staffs Inquiry (2013)

Nursing and Midwifery Council Investigation of systemic concerns

The Nursing and Midwifery Council needs to have its own internal capacity to assess systems and launch its own proactive investigations where it becomes aware of concerns which may give …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F228 Accepted

Mid Staffs Inquiry (2013)

Administrative reform

It is of concern that the administration of the Nursing and Midwifery Council, which has not been examined by this Inquiry, is still found by other reviews to be wanting. …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation as urgent (Hard Truths: the Journey to Putting Patients First, DHSC, …

F229 Accepted

Mid Staffs Inquiry (2013)

Revalidation

It is highly desirable that the Nursing and Midwifery Council introduces a system of revalidation similar to that of the General Medical Council, as a means of reinforcing the status …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F230 Accepted

Mid Staffs Inquiry (2013)

Profile

The profile of the Nursing and Midwifery Council needs to be raised with the public, who are the prime and most valuable source of information about the conduct of nurses. …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F231 Accepted

Mid Staffs Inquiry (2013)

Coordination with internal procedures

It is essential that, so far as practicable, Nursing and Midwifery Council procedures do not obstruct the progress of internal disciplinary action in providers. In most cases it should be …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F232 Accepted

Mid Staffs Inquiry (2013)

Employment liaison officers

The Nursing and Midwifery Council could consider a concept of employment liaison officers, similar to that of the General Medical Council, to provide support to directors of nursing. If this …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F233 Accepted

Mid Staffs Inquiry (2013)

For joint action Profile

While both the General Medical Council and the Nursing and Midwifery Council have highly informative internet sites, both need to ensure that patients and other service users are made aware …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F234 Accepted

Mid Staffs Inquiry (2013)

Cooperation with the Care Quality Commission

Both the General Medical Council and Nursing and Midwifery Council must develop closer working relationships with the Care Quality Commission – in many cases there should be joint working to …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F235 Accepted in Part

Mid Staffs Inquiry (2013)

Joint proceedings

The Professional Standards Authority for Health and Social Care (PSA) (formerly the Council for Healthcare Regulatory Excellence), together with the regulators under its supervision, should seek to devise procedures for …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation in principle (Hard Truths: the Journey to Putting Patients First, DHSC, …

F236 Accepted

Mid Staffs Inquiry (2013)

Identification of who is responsible for the patient

Hospitals should review whether to reinstate the practice of identifying a senior clinician who is in charge of a patient's case, so that patients and their supporters are clear who …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F237 Accepted

Mid Staffs Inquiry (2013)

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 …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F238 Accepted

Mid Staffs Inquiry (2013)

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 …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F239 Accepted

Mid Staffs Inquiry (2013)

Continuing responsibility for care

The care offered by a hospital should not end merely because the patient has surrendered a bed – it should never be acceptable for patients to be discharged in the …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F240 Accepted

Mid Staffs Inquiry (2013)

Hygiene

All staff and visitors need to be reminded to comply with hygiene requirements. Any member of staff, however junior, should be encouraged to remind anyone, however senior, of these.

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F241 Accepted

Mid Staffs Inquiry (2013)

Provision of food and drink

The arrangements and best practice for providing food and drink to elderly patients require constant review, monitoring and implementation.

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F242 Accepted

Mid Staffs Inquiry (2013)

Medicines administration

In the absence of automatic checking and prompting, the process of the administration of medication needs to be overseen by the nurse in charge of the ward, or his/her nominated …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F243 Accepted

Mid Staffs Inquiry (2013)

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 …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F244 Accepted

Mid Staffs Inquiry (2013)

Common information practices shared data and electronic records

There is a need for all to accept common information practices, and to feed performance information into shared databases for monitoring purposes. The following principles should be applied in considering …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F245 Accepted in Part

Mid Staffs Inquiry (2013)

Board accountability

Each provider organisation should have a board level member with responsibility for information.

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F246 Accepted

Mid Staffs Inquiry (2013)

Comparable quality accounts

Department of Health/the NHS Commissioning Board/regulators should ensure that provider organisations publish in their annual quality accounts information in a common form to enable comparisons to be made between organisations, …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F247 Accepted

Mid Staffs Inquiry (2013)

Accountability for quality accounts

Healthcare providers should be required to lodge their quality accounts with all organisations commissioning services from them, Local Healthwatch, and all systems regulators.

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …

F248 Accepted

Mid Staffs Inquiry (2013)

Accountability for quality accounts

Healthcare providers should be required to have their quality accounts independently audited. Auditors should be given a wider remit enabling them to use their professional judgement in examining the reliability …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation in principle (Hard Truths: the Journey to Putting Patients First, DHSC, …

F249 Accepted in Part

Mid Staffs Inquiry (2013)

Accountability for quality accounts

Each quality account should be accompanied by a declaration signed by all directors in office at the date of the account certifying that they believe the contents of the account …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation in part (Hard Truths: the Journey to Putting Patients First, DHSC, …

F250 Accepted in Part

Mid Staffs Inquiry (2013)

Accountability for quality accounts

It should be a criminal offence for a director to sign a declaration of belief that the contents of a quality account are true if it contains a misstatement of …

- The government's response in "Hard Truths" (Cm 8777, November 2013) accepted this recommendation (Hard Truths: the Journey to Putting Patients First, DHSC, November 2013). …