The NHS and all who work for it must adopt and demonstrate a shared culture in which the patient is the priority in everything done. This requires :
- a common set of shared core values and standards shared throughout the system
- leadership at all levels from ward to the top of the Department of Health, committed to and capable of involving all staff with those values and standards
- a system which recognises and applies the values of transparency, honesty and candour
- freely available, useful, reliable and full information on attainment of the values and standards
- a tool or methodology such as a cultural barometer to measure the cultural health of all parts of the system.
Shared core values and standards:
- the core values and expectations for the NHS set out in the NHS Constitution will continue to be promoted
- the development of values based recruitment by Health Education England will reinforce the importance of values as the driving force of the NHS
- the Care Quality Commission has conducted a major consultation on a new set of fundamental standards of care which will set out the inviolable principles of safe, effective and compassionate care that must underpin all care in the future
- the introduction of a new and robust inspection regime is an important shift in the way nationally the system will ensure poor care is identified and tackled.
Leadership at all levels
- we recognise the importance of leadership at all levels in ensuring that we prevent terrible failures of care of the kind we saw at Mid Staffordshire NHS Foundation Trust, and welcome the connection made in this recommendation between effective leadership and the engagement of staff.
- the NHS Leadership Academy is developing and implementing a wide ranging programme of leadership support at all levels of the NHS, with a strong emphasis on values.
Information on the attainment of the values and standards
- the NHS needs to do much more to put in place a transparent approach to providing care and to working with patients. The shift to greater transparency is the foundation for the culture of honesty and candour that this recommendation calls for
- legal changes are being put in place that place a statutory duty of candour on healthcare providers and which create a new offence of providing false or misleading information. It is believed that the combination of positive reinforcement of the value of openness with sanctions for the most serious failings in candour and honesty will support the NHS to become a far more open culture than the one examined by the inquiry’s report.
- that NHS organisations need to be accountable to the people they serve for the ways in which they have lived up to the values and standards expected of them. This will be in part achieved through the use of fundamental standards of care by the Chief Inspector of Hospitals.
Measuring cultural health
- it is important to ensure there is a clear understanding of the cultural health of different parts of the NHS. Regular inspection will provide the basis for a new, clear, transparent system of ratings that will be accessible to the public. All acute hospitals in England will have been inspected by the end of 2015
- the Care Quality Commission is developing a set of indicators for inspecting all providers of NHS care, and this will permit judgements to be made about the culture of the organisation in question as well as other elements of its performance.
- in June 2013, the Care Quality Commission issued A new start – Consultation on changes to the way CQC regulates, inspects and monitors care. In this, the Care Quality Commission suggested that a ‘well-led’ service is one where there is effective leadership, governance (clinical and corporate) and clinical involvement at all levels of the organisation, and an open, fair and transparent culture that listens and learns from people’s views and experiences to make improvements. They confirmed their plan was to encompass an assessment of aspects of governance, leadership and culture as part of its inspections to assess whether a service is ‘well-led’
- the boards of NHS organisations at all levels have a central responsibility to pay close attention to the culture of their organisation, actively dealing with cultural risks and seeking improvements in their organisation’s culture, drawing on support mechanisms such as the cultural barometer that is being developed by the National Nursing Research Unit at King’s College London along with other organisations. We would expect boards to be transparent about this with patients and the public.
The Department of Health has put in place a number of measures to address the elements of this recommendation. The detail of what the Department of Health have done is set out in the report on progress ‘Culture Change in the NHS – Applying the Lessons of the Francis Inquiry’ and in the updates we have provided on progress against other recommendations made by Sir Robert Francis QC.
Amongst those measures are:
- Shared core values and standards
- The Department of Health is consulting on a number of measures in relation to the NHS Constitution in response to the recommendations made in the Inquiry report.
- Publication of a values-based recruitment framework to support recruiting for values.
- Fundamental standards of safety and quality incorporated into the requirements for providers registered with the Care Quality Commission.
- A new, robust inspection regime in place for hospitals, primary care and social care.
- Leadership at all levels
- NHS Leadership Academy programmes launched to support leaders from ward to board to lead for safer, more compassionate care.
- Launch of the executive fast-track programme to increase the number of executive leaders in the NHS from clinical and non-NHS backgrounds.
- Information on the attainment of the values and standards
- The Department of Health and NHS England have made available an unprecedented amount of data on safety and outcomes on the ‘myNHS’ website.
- The statutory duty of candour applies to NHS care now and will apply to all Care Quality Commission registered care from April 2015.
- New inspection model for hospitals now being used across the NHS.
- Measuring cultural health
- New system of ratings in place, and the Care Quality Commission inspection model includes the assessment of how ‘well led’ an organisation is.
- The myNHS website includes hospital-level data on the ‘friends and family’ test; whether an organisation is recommended by staff; and on open and honest reporting.