The Francis Report: Guidance for Taking Responsibility

The Francis Report: Guidance for Taking Responsibility

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In the late 2000s the healthcare commission began an investigation into the Mid Staffordshire Hospital, England. Concerns come to light because of the hospitals unusually high mortality rates. When the Mid Staffordshire NHS Foundation Trust failed to provide an adequate explanation, the Healthcare Commission began a full-scale investigation. Years of unsatisfactory investigation eventually led to a full public inquiry, led by Robert Francis in 2010.

The final report, published in 2013, is what has come to be known as The Francis Report. The Francis Report has become a driving force to promote change, lead, shape, fund and improve all aspects of health care, and make sure that people receive the support, care and treatment they require, with the compassion, respect and dignity that they deserve.

The result of the Francis Report means that the NHS is at a turning point in how all Health Care is delivered, as suggested by NHS employers “28 of Robert Francis' QC's recommendations are for changes to nursing regulation or delivery”.

Not only does The Francis Report call for more compassionate care, but it also states that stronger leadership is required of all ward nurse managers. It also insists on a change with regards to the appraisal and support system for nurses. This appraisal system is a means of assessing the performance of nurses so that any shortcomings can be corrected through methods such as training and transfer. On the other hand, a positive assessment is to be rewarded by promotion.

Due to an ageing population , The Francis Report recommends the introduction of a new status of nurse, the “registered older persons nurse”. One of the illnesses linked in with this is dementia, and multiple factors relating to dementia are having an impact on how nurses are trained and their deliverance of services. In 2013, the Royal College of Nursing (RCN) began a new development program to transform dementia care for hospitals. There aim is to develop skills and knowledge related to dementia, the roles of all those who are involved, understanding the development of action plans that identify key changes.


Another focus for change is that over the years the demand for home and community care over hospital care has continued to grow, as stated by the Queens nursing institute “Recent health policy points to the importance of improving and extending services to meet the health and care needs of an increasingly older population and provide services which may have previously been provided in hospital within community settings”.

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(Maybe paraphrase this?) NO –GOOD AS IT ISAs well as values and behaviours, the focus has shifted onto the need for district nurses to make use of development and innovations in technology and service delivery if they are to meet the populations needs with the resources available. (Rewrite or paraphrase previous sentence)SOURCE OF INFO

In 2012 a new vision and strategy for nurses (as well as other health care professions) was published. Compassion in Care sets out six values that all nurses are to mirror within their practice.
These are the values that all nurses must meet future health needs with:

*Care
*Compassion
*Competence
*Communication
*Courage
*Commitment

These values are more commonly known as the 6c's, and not only are they the focal points the relationship between nurse and patient, but it is also expected that employers recruit nurses based on their positive behaviours and values, and that they continue to be passionate about providing a high level of care throughout their careers. SOURCE OF INFO

A professional body is an organisation that seeks to further a particular profession, the interests of those who are engaged in the profession, and the public interest. The main regulatory and professional bodies in relation to nursing are the National Midwifery Council (NMC) and the Royal College of Nursing (RCN).REFERENCE

A regulatory body has the authority to tell a professions what it may or mat not do. It regulates that chosen area. The NMC are the nursing and Midwifery regulators for England, Wales, Scotland & Ireland. They exist to safeguard the health and well-being of those who are engaged in that chosen profession, as well as patients and members of the public. The NMC also set set standards of education, training, conduct and performance, so that nurses and midwives cam deliver high quality health care consistently throughout their careers. They ensure that nurses and midwives keep their skills and knowledge up to date and uphold the NMC professional standards, but also investigate nurses and midwives who fall short of those standards.

The positive aspects of the NMC is that they provide a vast amount of protection, information and support to nurses and protection to both nurses and patients. The only major negative point is that it is mandatory to pay the annual £100 to the NMC. (Expand upon this) (Write about how they punish nurses etc)

The RCN are a professional body that represent nurses and their profession, promote a high standard of practice and shape health policies. They are similar to a union, but are more education based. They aim to keep the profession informed and up to date with current events. They are the largest profession body for nursing in the UK. They support over 410,000 members who are nurses, midwives, health care support workers and students from a variety of nursing disciplines and sectors. They are the voice for all of their members locally, nationally and internationally.
Their roles also consist of educating nurses professionally and academically, influence governments and others to develop and apply policies that improve the quality of patient care. Similarly to the NMC, the RCN protect the interests of nurses, their values in all their diversity and the terms and conditions of employment in all sectors.SOURCE OF INFO

All of these are very positive points about the RCN, their major downfall though is the annual fee of £194.93, or the monthly fee of £16.24. The only real positive thing about the payment is that students only pay £10 a month.


A code of conduct is a set of rules that outline the responsibilities and proper practices for an individual, party or organisation. They are there to refer back to if anyone does break the codes of conduct. The code of conduct is the foundation of good nursing and midwifery practice, and a key tool in safeguarding the health and well-being of the public. (positives and negatives)
NEEDS EXPANDING



A team is a group of people who work together in order to provide services for which they are mutually accountable. The team shares goals and are mutually responsible for meeting them, but each member individually affects results through their meetings and interactions with each other. Because each member of the group plays a vital role, integrating with one another is included among the responsibilities of each member.

The Multidisciplinary Team (MDT) follows the same aspects of a normal team, but consists of a group of healthcare and social professionals from different backgrounds who provide different services for patients in a co-ordinated way. The multidisciplinary team is tailored around the patient, so depending on the patients condition or disease being treated the types of team members will vary. SOURCE OF INFO

The MDT has multiple benefits and positive aspects, members of a team that work together in a care setting experience lower levels of stress if the team objectives are clearer, team participation is high, the emphasis on quality is greater and there is a high level of support for innovation within the team. (Reference: Homepages.inf.ed) People who work in teams have shown that they are more effective at their work roles, and possess a greater understanding about what their job entails because of a high level of teamwork that results in good communication. There is generally more co-operation, and not just within the team, but within the NHS as a whole. Those who work in a team also find that they have a high level of social support. This is because team members are able to support each other both emotionally and practically through hardships. The result is more positive work attitudes, and higher quality care.SOURCE OF INFO

An important component for the MDT is leadership, without strong leadership the rest of the group will surely fail. It is the leaders job to constructively help other members, make sure the team has a high level f co-ordination, continuously help the team to improve, provide objective analysis and encouragement and promote enthusiasm & confidence. They are basically the glue that holds the group together, and clear leadership contributes to effective team processes, to high patient care and to innovation.

Most aspects of the MDT are positive, but there are negatives too. Communication is important within a multi-disciplinary team if the team is going to work effectively, without it the team may not be able to co-ordinate their efforts to reach their goals. Lack of communication in a care setting can be hazardous to the patient, mistake can easily occur. The team must have meetings in order for information to be correctly shared, without these meeting, decisions may not be made correctly, and a shared understanding about the tasks at hand cannot be developed. Different perspectives need to be carefully discussed which leads to better quality decisions bout patient care.SOURCE OF INFO

The main positive of the MDT is that the whole group is there to provide for and support each other as well as the patients and their families. The main downfall of the MDT is that one weak link can cause the whole chain to fall apart, and within a team it is not the individual that must take responsibility, but the whole team.


Things do not always run smoothly within the NHS, and when this occurs a call for policy change is needed. Organizations such as RCN support nurses during these changes, they work with a variety of stakeholders, including government and think tanks, on the development and implementation of policy to ensure nursing influence and voice. (http://www.rcn.org.uk/support/policy )

The RCN have also implemented some processes, so that nurses may partake and be more involved during policy development. These methods involve seminars, workshops, surveys and briefings.

A good example of this would be the Francis Report. Because of all the issues that were occurring at Mid Staffordshire Hospital, many changes were implemented. For example, the majority of the staff were aware of the malpractice, but were either comfortable in believing that this was the norm, or they felt too frightened to report their worries and concerns. The Francis Report has made it easier for those working in health care to report any issues that they may have. The Francis Report is also attempting to tackle the issue of the increasingly growing elderly population, and the shortage of hospital beds, by having nurses who specialise in caring for the elderly, and an emphasis on improving community care. This will call for a complete change in policies, and although professional bodies do support most of these changes, they often have their own view on things. For example, the NMC report (Reference) states that: “The NMC believes the skills and experience to support older patients should be universal, and does not support a new status of a registered older person’s nurse. “.

Being able to influence policy is important because, as mentioned above, not everyone will agree with the changes. That's why professional bodies are very important, they are the voice for all nurses which means they are there to express all opinions. Thee nurses are the ones on the front lines, they understand what may or may not need to be done, and without collective input and discussion the wrong decisions could be maDE.

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