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Commissioner pressure cracking trusts, Francis update finds

Commissioner pressure cracking trusts, Francis update finds

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Commissioners have been urged to be "responsible" when increasing demands for assurance from trusts, as a report reveals financial pressures and a complex regulatory environment are making it difficult for hospitals to implement the recommendations of the Francis report. 

By conducting in-depth interviews with staff at acute hospital trusts and online surveys of the chairs and chief executives of more than a third  of the acute and foundation trusts in England, the Nuffield Trust found that ensuring safe staffing levels is currently proving difficult. 

Although 82% of the hospitals said they were taking action in response to the Francis report, some hospital boards were finding it hard to meet increased demands for assurance and scrutiny from external regulators and commissioners. 

Leaders described a "burdensome" regulatory approach that seemed to be at odds with their efforts to develop an open quality-focused culture in their own organisations. One leader told the Nuffield Trust: "I’ve never, in my whole career, felt more regulated."

Robert Francis QC (pictured), who acted as an advisor to the research, said: "It is reassuring to see that in large part the respondents to this research appear to have embraced the need to learn from the two inquiries into Stafford and the alarming events which they described. In particular there appears to be general acceptance that quality needs to be given a much greater priority.

"It is concerning, however, that some respondents reported that national bodies have persisted in some of the behaviours towards hospitals that evidently contributed to the problems identified by the two inquiries. If true, it would suggest that the lack of co-ordination and elements of the system-based culture so evident in the regulation and oversight of Mid Staffordshire have persisted in spite of the assertions to the contrary by the regulators."

'Fair and responsible'

The study notes that while hospitals are being encouraged to use ‘cultural barometers’ to assess the health of their own organisations, there is no similar mechanism in place to assess the behaviour and functioning of the wider NHS system.

Ruth Thorlby, report lead author and Senior Fellow in Health Policy at the Nuffield Trust, said: "Many of the strategies being used to improve quality, such as boosting nursing numbers, are resource intensive and hospitals are also under huge financial pressure.

"Some of the interviews suggested that hospitals are involved in exacting interactions with commissioners and regulators, which have also responded to the Francis Inquiry findings by seeking increased assurance that quality and efficiency are being delivered by hospital trusts.

"It is important that these interactions between hospitals and the wider NHS system are conducted in a fair and responsible manner, and that there is some independent and evidence-based way of establishing whether the dysfunctional relationships amongst the regulatory and commissioning bodies and between them and hospitals described in the Francis Inquiry have been rectified and improved."

The report was released to mark the anniversary of the Francis Inquiry report, which highlighted a whole system failure at the Mid Staffordshire foundation trust. The Francis report had 290 recommendations with implications for all levels of the health service in England. 

The full Nuffield Trust report is available to view online

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