In June 2010 the Government asked Robert Francis QC to undertake a public inquiry into the role that commissioning, supervisory and regulatory bodies played in monitoring the work of Mid Staffordshire NHS Foundation Trust. The request followed his earlier independent inquiry into the care provided by the hospital trust. This section outlines how Nuffield Trust researchers have engaged with the Public Inquiry, and our planned future activities in this area.
Following publication of his final report, Robert Francis QC spoke at the Health Policy Summit 2013 where he outlined the main findings and the challenges they pose for those working in the health service.
The Inquiry’s final report was published on Wednesday 6 February 2013. It addresses a range of issues of concern to NHS managers, clinical staff and patients, as well as policy-makers and national bodies.
These include the recruitment, training and competency of staff, the regulation of care services, the science of quality measurement, the role of public voice and oversight, and the degree to which those working in the NHS feel empowered, supported and engaged.
We are exploring how hospitals and their boards have responded to the Inquiry and what they are doing to focus on the quality of care in a time of financial austerity
Read our response to the Inquiry’s recommendations, which focuses on those areas where the Nuffield Trust has particular expertise, such as NHS funding, patient-level data, commissioning and regulation.
Our response strongly endorses the Inquiry’s main message that listening to and understanding patients must come first, at all levels of the NHS. But it also warns the Government (in taking forward the quality agenda) of the risks inherent in adopting a ‘big stick’ or punitive approach to the providers of health care.
On 19 November 2013, the Government published its full response to the Mid Staffordshire NHS Foundation Trust Public Inquiry, including new transparency measures for hospital trusts.
The Nuffield Trust issued a statement at the time, supporting this emphasis on openness, but warning that the raft of new measures carried risks of over-centralisation. We urged the Government to look further at the changes needed in central bodies and regulators, as well as hospitals.
At the request of the Inquiry Chairman, the Nuffield Trust prepared several submissions covering some of the matters addressed as part of the Inquiry. These papers were:
As part of the Inquiry seminar on commissioning, Dr Judith Smith, Nuffield Trust Director of Policy, talks about what we can learn from the different iterations of health care commissioning in England.
In addition to the commissioned work described above Dr Judith Smith, Director of Policy, Nuffield Trust, appeared before the Inquiry as an expert witness. Dr Judith Smith gave expert evidence on the 15-16 November 2010 (click here and here to read the transcripts).
A number of the issues raised by the Inquiry, particularly the regulation of care services, commissioning, and measurement of quality, are long-standing issues of interest to the Nuffield Trust. Our research programme touches on all of these issues and we will be taking forward various projects that aim to provide new insights in these areas.
The centrepiece of our work in this area is a project to examine the nature and scale of the response by acute hospital trusts and foundation trusts to the findings and recommendations of the Francis Inquiry report.
Through a national survey, we will explore which of the many themes from the report have been prioritised by trust boards and staff, and how the report’s recommendations have been received at a time of financial crisis and rising demand, and in an increasingly complex regulatory environment.
In addition, through a series of case studies of trusts and foundation trusts, we will explore in more detail how the Francis report was perceived by a range of board members, clinical and managerial staff. We are seeking to gain some insight into how hospital trusts are developing, and where necessary changing, organisational and team culture, and working to ensure the delivery of consistently compassionate care.
The survey and case studies have been preceded by an analysis of trust and foundation trust board papers drawn from a sample of hospital organisations in England. The board paper analysis has informed the content of the project survey and acted as a guide to developing a sampling frame for the case studies.
A report of this work will be published in February 2014, one year on from the Inquiry’s publication. To be first to download the report and access related resources, sign-up to our email alerts on quality of care.