Public Inquiry Recommendations

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- The National Patient Safety Agency's "Being Open" guidance (2009) was superseded by the statutory duty of candour under Regulation 20 of the Health and …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

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, …