Download WLMHT reponse to Francis Report - West London Mental Health Trust

WLMHT Initial Response to Report of the Mid Staffordshire NHS Trust
Public Inquiry – Report to the Board
Introduction
The report of the Mid Staffordshire NHS Trust Public Inquiry chaired by Sir
Robert Francis was published in February 2013 and includes 290
recommendations, many of which relate to national professional, statutory and
regulatory bodies and require a response from those agencies before the
Trust will be in a position to describe plans to implement any required actions.
Therefore, this report contains details of the Trust’s initial response to the
recommendations and refers to areas where compliance has been
established or where plans are in place to implement change in the light of the
recommendations of the public inquiry.
Background
Concerns about mortality rates, patient safety and standards of care delivered
at Mid Staffordshire Trust arose circa 2007. As a result, a number of
investigations and reviews were commissioned, including one by the Health
Care Commission which published its report in March 2009 and an
Independent Inquiry chaired by Sir Robert Francis, the report of which was
published in February 2010. What emerged from the investigations, reviews
and first Francis inquiry was a horrifying picture of the Board of an acute Trust
preoccupied with achieving challenging financial recovery and savings plans
at the expense of patient care and safety in order to gain Foundation Trust
status. The chain of negative impacts on quality of care has been well
described in terms of extreme staff shortages, reliance on poorly trained and
stressed, often unregistered staff at the clinical front line who were often
uncaring and blunted to distress, paralleling the uncaring, bullying way they
were in turn treated by their managers. Indeed, a culture of threat and bullying
was revealed which permeated every level of the organisation, with the most
vulnerable patients experiencing the greatest harm. Elderly, confused and frail
patients were found to have been treated in dehumanizing ways, being denied
dignity and support for the basic activities of living they were unable to
manage because of their ill health. Also, patients whose admissions occurred
as an emergency and who were treated through the Trust’s emergency care
pathway were amongst those who suffered most, becoming victims of a target
culture whereby pressure was applied on clinicians to accelerate patients
through the pathway, prioritising the achievement of waiting time targets for
example, over the care and treatment patients needed as a result of their
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health conditions. Failures at every stage of the pathway from triage to
discharge were identified.
Patient safety was greatly compromised due to failure to meet cleanliness and
infection control standards, not administering medications as prescribed, poor
support and management of the care of people with mobility difficulties
leading to falls, and poor care with regard to prevention and treatment of
pressure ulcers. Essential equipment for patients’ treatment was in poor repair
or lacking. The Trust was found to be inward looking, with the Board meeting
in private and detached from the reality of the wider organisation, whilst
inappropriately relying on external agencies and regulators for quality
assurance. Data that suggested poor quality of care delivered at the Trust
was met with denial followed by undue scrutiny around coding and data
issues rather than concern about possible implications for patient safety.
Senior clinicians, mainly consultants were described as disengaged from
Trust management.
In June 2010 the secretary of state for health announced a Public Inquiry into
Mid Staffordshire NHS Foundation Trust to be chaired by Sir Robert Francis.
Having established a clear and consistent description of the failings at the
Trust in previous inquiries, the remit of the Public Inquiry was to examine the
functioning, cultures and systems of commissioning, supervisory and
regulatory organisations and other agencies in relation to their monitoring role
at Mid Staffs and establish why problems were not identified sooner and to
identify lessons to be learnt about assuring quality of patient care and safety.
Findings - Report of the Mid Staffordshire NHS Trust Public Inquiry
(2013)
Many reviews had occurred and much data was available about aspects of
care and safety at Mid Staffs but this had not been identified by the Trust or
other agencies as predictive of or associated with extremely poor quality,
including risk to patients. ‘Vestigial’ governance processes were described
which were not fit for purpose and did not focus on the effect of the service on
patients while the Trust took false assurance from the findings of external
agencies whose assessments inevitably lacked depth. The Trust also took
assurance from the fact other health care providers performed as badly rather
than acting in a patient centred way and responding with concern about any
detrimental effects on patient experience and safety. ‘Specious’ complaints
and incident reporting occurred whereby exploration did not occur beyond
surface presentations. There was not found to be any management culture of
listening to patients or carers and no quality impact assessment of the major
staff reductions that occurred to make financial savings. Poor medical but
mostly nursing standards and performance were associated with a failure to
take up the challenge of building a positive culture. Patient safety failures
were associated with not appreciating the risks associated with disruption and
also lack of corporate memory and focus due to repeated, multi – level
reorganisations. External regulatory agencies were described as doing the
system’s business not patients.’
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Recommendations
As mentioned previously, not all of the 290 recommendations made by
Francis (2013) require an immediate response from WLMHT as they either
refer to actions required by external agencies or require those external
agencies to make an initial response to which WLMHT will then be required to
react.
WLMHT Response
Immediate Response
The immediate response by WLMHT Board was to undertake critical self
assessment during Board development sessions, identifying any obvious
indicators or performance approximating the findings at Mid Staffs. The Trust
identified a lead for the implementation of recommendations from the Mid
Staffs Public Inquiry, the Interim Director of Nursing and Patient Experience.
The Trust also agreed to cascade the findings of the Mid Staffs Inquiry
throughout the Trust in order to generate comments and feedback from staff
groups regarding any parallels with Mid Staffs and also with regard to ideas
about improvement. To date numerous presentations have taken place within
the Trust with more planned. Also, the Interim Director of Nursing and Patient
Experience will support nominated staff from across the trust to present the
report and generate feedback from within their teams, deeper into the clinical
and corporate services. The Mid Staffs Inquiry was presented at the Trust
Leadership Forum on 25th February and at the Trust Health Care Assistant
and Support Worker conference on 18th March. It was central to the Trust
learning lessons event on 1st May and the Trust annual safeguarding
conference on 17th May. The Trust annual nursing conference on 3 rd July will
focus on compassion in mental health nursing. Therefore, the Trust response
will be continuous and evolve as part of an iterative process which
incorporates feedback, ideas and actions from staff, service users and carers.
Importantly, it will build on current good practices.
Culture of Putting Patients First
Whilst maintaining a strong focus on individual accountability, the Trust also
recognises the impact of culture on staff attitudes and behaviour. The Trust
accepts that patients must come first in all that we do. With regard to culture
of the organisation, the Trust recognises that good staff engagement and
support is a prerequisite for patient centred-ness and the high quality
therapeutic relationships we want patients, service users and carers to
experience as part of their recovery. The Trust is also aware that some
members of staff feel alienated from the business of the Trust and that they
are ‘done to’ rather than actively involved in decisions that affect them. Some
staff also report feeling bullied. Additionally, some senior managers and
directors feel unable to understand what generates and sustains this position.
Furthermore, actions developed to resolve this picture appear to have failed to
make a difference year on year. A number of new initiatives are planned to
address this. Included is the drive towards a culture of engagement that
encourages staff to speak out about their experiences at the Trust. That is
evidenced by a series of listening events facilitated by the CEO, the
introduction of a Staff Engagement Committee reporting to the Board, the
introduction of staff reporters whose task is to each interview a cohort of
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colleagues about their experiences at the trust and then report to the Board in
a specially organised session utilising the fishbowl approach. The Board listen
to the reporters’ feedback and then set time aside to carefully consider what
they have heard. Action is then taken to improve staff experience and this will
be planned and monitored through the Staff Engagement Committee. Each
time staff reporters feed back to the Board, the consequent actions agreed
are communicated within the Trust in a newsletter entitled ‘Action for Change.’
Also, feedback from the Health at Work team who have a specific perspective
regarding staff experiences of the Trust will be used to inform strategies to
improve. An organisational consultancy will be engaged whose remit will be to
support the Trust to address complex aspects of workplace culture that may
require work to occur ‘below the surface’ as well as above the surface.
Openness, Transparency and Candour
A principle of putting patients first involves acknowledging, apologising and
providing clear support and information to patients and their families when
things have gone wrong or safety compromised including how the
organisation has responded and what lessons have been learnt. The Trust
has in place a ‘Being Open’ policy which addresses these principles and will
adhere to any further standards specified by the NHS Commissioning Board.
Listening to Patients and Carers
Patients and Carers are listened to within the Trust with several patient or
service user and carer forums in place. The Meridian Patient Experience
Feedback system has been invested in as a means of achieving real time
feedback. Clinical teams are embedding the practice of improving the quality
of patient and carer experience based on their feedback. All in - patient
services have regular community meetings where patients and staff come
together and patients are able to feedback on their experiences. Patient
representation is included in local clinical improvement groups and
governance meetings throughout the trust. Patients and carers regularly
provide narratives prior to Board meetings, reporting their experiences of
Trust services. Patients and carers provide training to staff throughout the
trust regularly, based on their lived experiences at the Trust. The Trust is
open to exploring further methods of gaining feedback, such as the ‘mystery
shopper’ approach. Enhanced use of complaints feedback is being explored.
A review of service user and carer involvement was commissioned in 2012
and the report of this review was presented to the Trust Board at the end of
May 2013. The recommendations were accepted. A working group has been
convened to implement the recommendations, beginning with developing a
centralised, supportive, co-ordinated infrastructure for service user and carer
involvement. Funding has been made available to support this initiative. A
further development is the introduction of a patient or service user and carer
led group which will actively challenge and hold the organisation to account
with regard to the nature and quality of services delivered.
The importance of carer involvement at all levels is positively encouraged.
The Trust provides therapeutic family interventions with staff increasingly
provided with encouragement, support and skills to work with families.
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Programmes of carer support and education are increasingly available within
Trust services. Welcome meetings are being piloted in some adult in – patient
settings. These meetings are a forum for carers to meet with the multi
disciplinary team treating their friend or family member, soon after admission,
providing the carers with an opportunity to become oriented to the services,
provide information to the treating team about the patient’s strengths,
resources and needs while also asking any questions or sharing any concerns
they may have. Additionally, The Triangle of Care (National Mental Health
Development Unit 2010) has been introduced to services.
Care, Compassion, Nurses and HCA’s
The Trust nursing strategy is currently under review. The revised strategy will
contain the following themes which concur with the recommendations of the
Francis Report and the 6Cs of the National Strategy for Nursing: Compassion
in Practice:

Restructuring the Director of Nursing post. This will free up time for
clinical practice and for support and engagement with front line nurses
in both in-patient and community settings.

Promoting compassion and the value and privilege of delivering
standards of basic care, which will be measured and reported into the
Trust Quality Committee.

Centralised assessment centre for recruitment which will include an
assessment of candidates’ aptitude for compassion, caring and the job
overall.

A new, more focused and competency based preceptorship
programme for newly registered nurses to be completed within their
first twelve months of qualification.

Investing in quality of nursing within our Older People’s Services,
including promoting its place amongst the other nursing specialties at
the Trust and ensuring staff receive appropriate support, supervision,
training and development within a career pathway.

Emphasising the nursing contribution to multi disciplinary teams by
building up evidence based practice and investing in training and
supervision to support the transition of learning into practice within the
specialist areas of psychosis, personality disorder and dual diagnosis,
child and adolescent mental health (as well as older people’s services).
This applicable to both community and in-patient settings.

Investing in a staff clinical supervision project delivered by a team of
international experts in the field. This project focuses on qualitative
aspects of clinical supervision and aims for clinical supervision which is
of an evidence based standard of effectiveness to be provided and
received by staff within the Trust.
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
A HCA training programme informed by Trust HCA’s and Senior
Nurses which is also in line with National HCA Training standards.
Inclusion of the code of conduct for HCA’s and Support Workers in
Trust job descriptions for these roles.

Nurse staffing will be reviewed annually and the findings presented to
the Quality Committee.

A Trust-wide Senior Nurse ‘back to the floor’ programme will be
initiated and centrally co-ordinated, increasing senior nurse visibility,
role modelling and support to front line staff whilst ensuring senior
nurses remain in clinical practice.

Continuing to support nurses to make a key contribution to
implementing the Recovery Approach in community and in-patient
settings

To embed a culture of nursing research, audit and evidence based
practice supported by the key joint appointment with Buckinghamshire
New University of the Professor of Mental Health
The revised strategy will be presented for consultation at the annual Trust
nursing conference on 3rd July 2013 where the keynote speaker is Jane
Cummings, Chief Nursing Officer for England who will be presenting
‘Compassion in Practice.’ The focus of the conference will be on implementing
‘Compassion in Practice’ within a mental health nursing context.
In March 2013 a HCA conference was held, which focused on Compassion,
Recovery and the role of the HCA. Delegates identified their training needs
and this information has been employed to inform a Trust wide standardised
training programme for HCAs.
Nurse staffing has recently been reviewed and the findings presented to the
Quality Committee. When benchmarked against other Trusts providing similar
services, Trust nurse staffing was favourable. As mentioned above, nurse
staffing will be reviewed on an annual basis.
Institute of Mental Health
In partnership with HEI’s and led by the newly appointed Professor of Mental
Health, WLMHT is exploring the development of an Institute of Mental Health
which will bring together, in an integrated way, the many strands of workforce
transformation and development, quality priorities and staff training ‘under one
roof.’ The focus will be on generating evidence based practical skills,
leadership development and team working. Importantly, training programmes
will be directly responsive to the needs of patients and carers and informed by
lessons learnt from patient and carer experience feedback, serious incident
reviews and complaints, as well as from workforce related data.
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Leadership
With regard to developing leaders capable of facilitating a patient centred
culture where patients and their families are treated with care and compassion
and whose voices are heard and included in the business of the organisation,
the Trust is implementing a comprehensive leadership development plan
around a competency approach which utilises the Talent Management
Framework.
Quality
The Trust Quality Strategy describes a comprehensive five year plan for
quality improvement at the Trust. It is the central component of the Trust
integrated business plan, reflecting the fundamental importance the Trust
places on continuously improving the quality of clinical services. In keeping
with the nature of recommendations from the Francis Report, one of the Trust
Quality Priorities is that all patients must be treated with dignity, respect and
compassion.
Recovery is central to the model of care at the Trust and is and of itself a
compassionate, patient centred approach to the delivery of mental health
services. The Quality Strategy was approved by the Board in March 2013.
With regard to the impact on quality of financial saving plans, the Trust has in
place a process of quality impact assessment which must be completed in
conjunction with any cost improvement plans.
Recovery
As mentioned, recovery is central to the model of care and the Trust has
invested in the implementation of the recovery approach. The Trust was an
ImROC pilot site for two years from 2011 and has now signed up as a
member of ImROC part two whereby the focus of a bespoke programme is on
embedding recovery practices in clinical teams. With the implementation of
the recovery approach, patients and carers are considerably more active in
the business of the trust with a number of experts by lived experience working
alongside clinicians in the organisation.
Board Contact with the Life of the Organisation
The Board takes several steps to ensure it remains in contact with the life of
the organisation, including the experiences of patients and staff. The Board
listens to a patient or carer narrative prior to each meeting and board visits to
corporate and clinical areas take place on a regular basis. Each month the
Board reviews a complaint in detail. The Trust receives details of complaints,
CQC visits and incidents each month and will receive an annual patient
experience report. The Board is considering how to achieve more in depth
review of patient complaints.
Trust Response to Specific Recommendations
The following matrix aims to provide details of the Trust response to specific
recommendations of the Mid Staffs Inquiry. The Board is asked to approve the
response to these recommendations. The next step would then be to inform a
comprehensive action plan from the recommendations.
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Themes from the report
What we already do well
Where we know we need to improve and what
we are doing about it
What is new for us
from the report?
Putting patients first
Patients must be the first
priority in all the NHS does by
ensuring that, within available
resources, they receive
effective care from caring,
compassionate and committed
staff, working within a common
culture, and protected from
avoidable harm and any
deprivation of their basic rights.
The Trust engages proactively with patients
across all services
Staff engagement – the Trust has nominated
‘Reporters’ to act as staff correspondents who
report to the Board regarding staff experience of
the Trust and back to the organisation through
Action for Change newsletters. The CEO hosts
listening events. The Trust has set up a Staff
Engagement Committee which reports to the
Board
Friends and Family
test – this is now
being taken forward
nationally by NHS
England; the Interim
Director of Nursing
is the nominated
lead for the Trust.
The NHS Constitution should
be the first reference point for
all NHS patients and staff and
should set out values, rights,
obligations and expectations of
patients.
Consider integrating patients
through representatives into
Trust structures
The Trust is fully committed to the recovery
approach and is participating in the ImROC
programme, which puts patients at the centre of
the care provided.
The Trust has mature and effective engagement
arrangements, such as patient / service user and An Action for Change workstream will ensure that
carer forums across all services
staff are made more involved in and aware of the
results of Trust consultations in order to improve
The Trust’s Meridian system is being rolled out
involvement and transparency in decision making
in order to record real time patient feedback
The Staff Charter is being updated with the NHS
The Trust ensures there is patient and carer
Constitution and the versions for staff and
engagement in Trust meetings and staff
managers are being consolidated into a single
recruitment
Trust Charter to ensure inclusivity
The Trust operates a programme of regular
Board member visits to services and reports
back to each Board meeting
Patient and carer stories are presented to premeetings of the Board to present first hand
accounts of the quality of our care
The Forensic service has published a booklet of
patients’ stories about their recovery journeys, to
inspire those who are newly admitted or early on
their treatment pathway
References to NHS
Constitution will be
included in job
descriptions and
contracts with
external agencies
working at the Trust.
The Trust is also
The Trust commissioned an independent review
including this in
of service user involvement, the report of this was equality impact
presented to Board in May 2013 and
assessments and
recommendations approved. A working group has staff codes.
been convened from this which will implement the
recommendations.
Encourage
communication
A new patient-led group has been formed to add between staff and
another layer of Board accountability for care
carers, including by
provided.
e-mail
The Trust is further developing its patient
experience report to Board
Explore how
patients can access
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The Trust is exploring the use of ‘mystery
shoppers’ as a way of receiving feedback on
quality of community services
A pilot will be commissioned whereby MHA
managers will undertake unannounced visits to
Trust services
Common culture
Commitment to common set of
values and accessible basic
care and treatment standards
and also:





Openness, transparency
and candour
Strong leadership in all
professions
Support for leadership
roles
Level playing field for
accountability
Information accessible and
used allowing comparison
of performance by
individuals, services and
organisation
The Trust’s revised quality strategy is strongly
values-driven and includes a five year
improvement programme, with established
monitoring arrangements
Learning lessons from CIPs – the Trust is setting
up a Change Management Office to consolidate
lessons learned from the implementation of
saving schemes and reflect these in ongoing CIP
planning and performance management
user friendly
information from
their records and
how they can enter
their comments if
they wish.
Develop a
systematic way of
following up patients
after discharge for
feedback
N/A
The Trust’s values are embedded in the
Integrated Business Plan, quality strategy and
annual business objectives.
The Reporter process and ongoing listening
exercises will provide an opportunity to review
progress against cultural priorities revealed by the
Information is produced at CSU level and can be staff survey over the course of the year
further disaggregated to give a comparable
picture of effectiveness across the Trust
The Leadership and Management development
programme is being revised and aligned with the
Board members meet regularly to undertake
NHS leadership competency framework.
structured development work. Relevant recent
topics include feedback from staff reporters, the One CSU produced a booklet outlining lessons
findings of the Francis report and the way
learned from incidents, which is to be rolled out
forward for the staff survey.
across the Trust.
Lessons learned from incidents are reviewed at
the Patient Safety and Safeguarding Committee,
with a range of local workshops also taking
The Trust is producing updated guidance on
whistleblowing to ensure staff are aware of how to
raise concerns and feel comfortable in doing so
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place. The Trust holds a central lessons learned openly.
summit annually.
Standards of service
Fundamental basic standards
of care need to be applied by
all those who work and serve in
healthcare.
Behaviours at all levels need to
be in accordance with at least
these standards.
Internal audit routinely reviews our compliance
with a selection of CQC essential standards
The Trust is establishing a standardised approach N/A
to lessons learned following service changes /
CIP implementation.
The Trust’s clinical audit function has performed
a Trust wide Patient Safety Audit, which was
The Trust is developing a compliance register
scoped around common themes / learning points where all compliance is registered and monitored.
from Serious Incidents.
The Trust is in proactive discussions with the
The Trust also undertakes Enhanced
CQC regarding their new visiting arrangements
Engagement and Observation Audits across all
and the role of the Chief Inspector of Hospitals.
inpatient services, which are crucial to
The regular series of liaison meetings is set to
measuring and improving patient safety.
continue.
The Trust has developed clear service
specifications in line with NICE guidelines for all
services. This is complemented by a
programme of clinical audit which assesses
compliance with NICE guidelines and identifies
any areas for improvement.
The Trust currently has no breaches of CQC
standards
The Trust appraisal system reflects Trust values
and staff are assessed in terms of their
behaviours against these.
The Trust proactively benchmarks its services
against other Trusts and uses this information to
inform the design and operation of our services.
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Complaints handling
Recommendations from
Patients Association’s peer
review into complaints at the
Mid Staffs should be reviewed
and implemented.
Making a complaint should be
easy and any concern made by
a patient should be treated as a
complaint unless the patient’s
permission is refused.
A senior clinician and nurse
should be obliged to be
involved in responding to
complaints to facilitate a
speedy resolution, wherever
possible.
Complaints relating to possible
breaches of basic standards
and serious complaints should
be accessible to the CQC,
relevant commissioners, health
scrutiny committees,
Communities and Local
HealthWatch.
Learning from complaints must
be effectively identified,
disseminated and made known
to the complainant and the
public, subject to suitable
anonymisation.
Complaints process is easily accessible for
patients and carers and viewed as a key source
of feedback by clinical staff and senior
managers.
All patients are made aware of the complaints
process (contact telephone number, website,
email address complaints team and PALS) and
who they can raise their complaints with,
including via the Advocacy service. This is
consistent across the trust.
Involvement of senior clinicians – senior
clinicians and nurses are involved in undertaking
complaint investigation and responding to
complaints consistently across the trust. Where
investigation is required, complaints are referred
to the service director/head of service to appoint
an investigator, usually a senior nurse manager
or the responsible clinician. All reports and
letters to patients resulting from the investigation
are agreed with the service executive directors
at the end of the investigation and signed off.
The Trust tracks actions from complaints via the
Exchange complaints database. The system
captures the outcome of complaints and
recommendations within each CSU. It is
recognised that further work is needed to refine
the complaints system to ensure that lessons are
learnt and being implemented on an ongoing
basis. Actions are discussed at relevant meetings
within the CSUs to go through outstanding action
plans from complaints. Centrally the actions are
reported via the quarterly reports and statutory
annual complaints reports which goes to the
service user & carer experience sub-committee
and Quality Committee for review and sign off.
The Trust will
publish anonymised
details of clinically
relevant upheld
complaints on its
website – subject to
consent of
complainant
The Trust plans to
develop a process
to regularly review a
sample of
complaints against
the findings of the
All complaints are logged and compliance with
Patient
deadlines is monitored through the Exchange
Association’s peer
system within each CSU and escalated if not
review. The
compliant. The central governance team
findings of this will
monitors compliance through KPIs, IPR, patient
be used to refine
experience quarterly and annual report and
the complaints
statutory annual complaints report. These reports review process
are provided to the Quality Assurance Committee,
service user & carer experience sub-committee
The Trust plans to
and the Board.
introduce a means
of assessing
The Trust’s PALS service has been ‘seeded’ into complainant
the CSUs. The overall structure of the PALS
satisfaction with the
service will be reviewed once the new Director of process.
Governance takes post (July 2013).
While the Trust does notify complainants about
lessons learned from their complaints, there is
more work to do around embedding and
monitoring change
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Performance Management &
Information
Through Quality Accounts, full
and accurate information about
a Provider’s compliance or
noncompliance with standards
should be published and
available on Trust website.
Quality Accounts should
contain observations of
commissioners and overview
and scrutiny committees.
Providers should publish real
time information on
performance of their
consultants and specialist
teams in relation to mortality,
morbidity, outcome and patient
satisfaction, and on the
performance of each team and
their services against the
fundamental standards.
Real-time information must be
provided to commissioners,
regulators and the public
should include statistics of
outcomes, and safety-related
information from investigations,
complaints and incidents.
Every provider organisation
should have a designated
board member as a chief
information officer.
Quality Account meets the DH requirements and
has been independently audited by our external
auditors – no significant issues raised.
Commissioners and other stakeholders provide
comments on our Quality Accounts which are
reflected in the document.
The planned replacement of RiO will further refine N/A
the quality of the Trust’s performance data,
including easier access to performance
information.
While performance information is already shared
with commissioners, a working group has been
set up to ensure that appropriate data are
routinely shared with the public.
Performance data can be disaggregated to
individual team level in terms of safety, patient
experience and clinical effectiveness.
The Integrated Performance Report has been
reviewed and ratified by the Board in order to
focus more clearly on those targets which are
sensitive, at risk or under-target.
Our Medical Director is designated Board
member for Information Governance and is the
Caldicott Guardian. The Director of Finance /
Deputy Chief Exec is our Senior Information
Responsible Officer.
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Openness, transparency and
candour
The NHS Constitution should
include clear obligations to
comply with the following
principles:
Openness: enabling concerns
to be raised and disclosed
freely without fear and for
questions to be answered;
Transparency: allowing true
information about performance
and outcomes to be shared
with staff, patients and the
public;
Candour: ensuring patients
harmed are informed of the fact
and that an appropriate remedy
is offered, whether or not a
complaint has been made or a
question asked about it.
Quality Accounts should be
accompanied by a declaration
by all directors certifying the
accounts to be true and
Providers should have their
quality accounts independently
audited
The Trust has a Being Open policy, which
already in place and well embedded
Nursing
Increased focus on a culture of
compassion and caring in
nurse recruitment, training and
education.
The knowledge and skills
HCA conference has been held and a
standardised HCA training programme planned
Openness – see common culture above
Transparency – see performance management
and information above
While the Being Open policy is up to date and
N/A
reflects national guidance, the Trust is currently
refining the monitoring and reporting
arrangements around this and reviewing the
serious incident and complaints policies to ensure
they are consistent.
Candour – see complaints handling above
Benchmarking against other Trusts has found
nurse staffing levels to compare well.
The WLMHT strategy for nursing is being
N/A
reviewed and will be circulated for consultation on
3td July 2013
The Chief Nursing Officer for England will speak
at the WLMHT Annual nursing conference
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framework should be reviewed
with a view to giving explicit
recognition to nurses’
commitment to patient care and
the priority
Ward nurse managers should
work in a supervisory capacity
and are not office bound. They
should be involved and aware
of the plans and care for their
patients.
There should be a responsible
officer for nursing in each trust,
and they should be
accountable to the NMC.
The Director of Nursing is registered with (and
therefore accountable to) the NMC and is the
responsible officer for nursing.
regarding ‘Compassion in Practice’
The Director of Nursing role will be reviewed to
allow more time in clinical practice and engaging
and supporting nurses
Recruitment centres will be implemented and
nurse and HCA applicants will be assessed for
aptitude for compassion and the job overall
A competency based preceptorship programme
will be introduced for newly registered nurses
The recovery approach will be adapted for
services for patients requiring high levels of
nursing support for basic care
The essence of care standards will be
implemented in services for older people
Professional development pathway will be
supported for nurses working in older people’s
care
Nurse education and training resources will be
focused on skills and knowledge required to meet
complex clinical needs, ensuring clinical skills are
accessible to patients. This will include PSI, dual
diagnosis, physical healthcare, dementia care,
CAMHS, Non medical prescribing and working
with personality disorder.
An institute of Mental Health will be developed in
collaboration with BNU and other HEI partners
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Standardised training will be provided for Health
Care Assistants and Support Workers across the
Trust, incorporating National Standards for Health
Care Support Workers and the HCA code of
Conduct
Clinical supervision project will ensure quality of
clinical supervision delivered is effective to
improve clinical skills and in providing personal
support to the supervisee
Mandatory training and supervision will be
provided for bank nurses
Standards for Ward Manager and Clinical Team
Leader presence in clinical areas will be agreed.
Nursing metrics and indicators will be agreed
across the Trust and reported and monitored
though the nursing and quality governance
framework
Nurses will work in partnership with estates and
facilities to maintain high environmental
cleanliness standards.
A formalised system for assuring standards of
medication management will be introduced
A governance framework for nursing which
ensures a line of reporting into the Trust Quality
Assurance committee will be agreed and
implemented
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A centrally co-ordinated ‘back to the floor’
programme for senior nurses will be implemented
Leadership
The common culture and
values of the NHS must be
applied at all levels of the
organisation, particularly to
leaders.
A common code of ethics,
standards and conduct for
senior board-level healthcare
leaders and managers should
be produced and should be
consistent with the common
culture (Fit and Proper Persons
Test).
Board has recently undertaken a skills audit and
is continuing to roll out its Development
Programme.
Talent management programme is being
developed and rolled out to ensure all staff have
access to leadership development opportunities.
The Trust has a common code of ethics and
values which is available to all current members
of staff and sent to all new joiners as part of the
induction process.
The Trust is reflecting on the Fit and Proper
Persons Test as part of its ongoing Board
Development work and FT application.
N/A
The principles appearing in
those ethics and standards
should apply to all staff, and it
is the responsibility of
employers to ensure that they
are honoured.
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Conclusion
The Board at WLMHT responded immediately and positively to the publication
of the Report of the Mid Staffordshire NHS Public Inquiry by undertaking
critical self assessment, reflecting on where there may be indicators of
performance approximating the findings at Mid Staffs and where
improvements could be made in the light of them. This process of critical
assessment and reflection is being mirrored across the Trust and a plan is in
place to facilitate this within individual teams. Feedback will be used in an
iterative process as part of a continual Trust response to the Mid Staffs Inquiry
whereby reflection will be used to identify improvements within teams which
will be implemented and monitored. Key areas of initial response are;
 Aspects of organisational culture, especially that which relates to staff
reports of experiencing bullying and threat
 Extensive leadership programme
 Increasing support to nurses and HCA’s in delivering standards of
basic care
 The centrality of treating patients with dignity, respect and compassion
as a quality priority
 A Comprehensive Quality Strategy
 Extending the scope of how service user and carer feedback is
employed within the Trust
 Further implementation of the Recovery Approach
In summary, WLMHT has taken the findings at Mid Staffs very seriously
indeed and has responded by utilising the lessons learnt to improve
performance and quality of care at this Trust over the long term. An
implementation plan will be developed from this report. The implementation
plan will be presented at the Trust Quality Committee on 11 th July and
monitored through that meeting thereafter.
Anne Aiyegbusi
Interim Director of Nursing and Patient Experience
14th June 2013
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