Does the Francis Report go far enough? asks Annie of Annie Barr Associates


The Francis Report, published on February 6, highlighted the need for organisations to create and maintain the right culture to deliver high-quality care that is responsive to patients’ needs. Annie Barr, Managing Director of Annie Barr Associates, takes a scalpel to the Francis Report, and asks whether it goes far enough.

Among its many recommendations were proposals that units within the NHS which failed to meet basic standards of care should be prevented from providing those services and if those failings led to death or serious harm to patients, legal sanctions including custodial sentences were appropriate. The  Francis Report also recommended that NHS staff should face prosecution if they hid information about poor care and should be compelled to be open with patients about mistakes.

The long-awaited report generated 290 recommendations designed to deliver ‘fundamental change’ to prevent the public losing confidence in the health service. There is sadly still much to do, and the report’s recommendations need to be implemented in a timely and sensible manner. There are likely to be many changes in the way health and social care is scrutinised and regulated following the Francis Report‘s recommendations. The report should go further, in my view, in that there should be a requirement that anyone wishing to enter the caring professions needs to spend a period of time working with patients directly. This should include hands on physical care. National standards for Health Care Assistants and Support Workers should be implemented throughout the UK. In addition, there needs to be a requirement for regulation of these workers and that duty should fall within the remit of the regulatory bodies of the NMC and RCN.

The Francis Report recommends an increased focus on training and professional development. At its heart, nurse training should require practical assessments and competence based approaches to ensure that Health Care Assistants (HCAs), trainee and qualified nurses are up to regulated standards. It is vitally important that quality of service is at the heart of all professional development courses for nurses, health care assistants and support workers. This will ensure that a consistently high and continuing level of quality of care is given to patients. Training courses for HCAs should cover mandatory subjects including accountability and responsibility.

Nursing leadership should begin with HCAs: Basic management and leadership of these vital support staff should be addressed. Along with nurses, they are in the frontline of care in this country. It is therefore vital that HCAs and nurses are able to undertake professional development courses covering key areas such as supervision, mentoring, coaching and competence assessments. Nurses should be able to access these courses and have regular mandatory updates on both leadership and clinical courses. Course topics should cover subjects such as how to understand yourself and your team, people and performance management, and change management. All too often nurses are ill equipped in management skills.

The HCA role should be tightly regulated and care should be taken to ensure that all professionals are registered. It is a fact that the HCA role has, in many cases, including primary care replaced the duties of the practice nurse. An HCA now undertakes health screening and many other roles such as assisting in the flu and diabetic clinics.

The HCA role is more developed in primary care than in hospital care and the difference in duties and tasks can be vast. The devolvement of responsibility from doctors to nurses and nurses to HCAs is a fait accompli. If HCAs are replacing the old enrolled nurses of the past, then there is a need to either add enrolled nurses back into the system or to train HCAs in more practical based focuses such as care and compassion.

HCAs should be financially compensated at a realistic level, and employers should follow the guidance of the knowledge and skills framework for HCAs according to their skill level and responsibilities. All professional development training courses for HCAs or Support Workers should be accredited at level three or four and practical assessments need to be included in theoretical training programmes.

There is little doubt that the Francis Report represents a step in the right direction in addressing the urgent, and serious, requirements of a care sector in distress. If we are to see real advances in patient care, however, the recommendations need to go above and beyond what is required as a minimum. They need to address the very serious issues blighting our care sector, and to put the high standards and the word ‘care’ back into professions that were once held in high esteem, both in the UK and abroad.

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