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The University of Manchester ResearchResponses to FrancisLink to publication record in Manchester Research ExplorerCitation for published version (APA):Chambers, N., Thorlby, R., Boyd, A., Smith, J., Proudlove, N., Kendrick, H., & Mannion, R. (2018). Responses toFrancis: changes in board leadership and governance in acute hospitals in England since 2013. The full report.Citing this paperPlease note that where the full-text provided on Manchester Research Explorer is the Author Accepted Manuscriptor Proof version this may differ from the final Published version. If citing, it is advised that you check and use thepublisher's definitive version.General rightsCopyright and moral rights for the publications made accessible in the Research Explorer are retained by theauthors and/or other copyright owners and it is a condition of accessing publications that users recognise andabide by the legal requirements associated with these rights.Takedown policyIf you believe that this document breaches copyright please refer to the University of Manchester’s TakedownProcedures [http://man.ac.uk/04Y6Bo] or contact uml.scholarlycommunications@manchester.ac.uk providingrelevant details, so we can investigate your claim.Download date:09. Jun. 2021
Responses to Francis: changes in board leadership andgovernance in acute hospitals in England since 2013Full Report VersionJanuary 2018List of contributors:Naomi Chambers*, Alliance Manchester Business School, University of ManchesterRuth Thorlby, The Health FoundationAlan Boyd, Alliance Manchester Business School, The University of ManchesterJudith Smith, University of BirminghamNathan Proudlove, Alliance Manchester Business School, The University of ManchesterHannah Kendrick, University of EssexRussell Mannion, University of Birmingham*Corresponding authorThis report is an output from independent research commissioned and funded by the Department of HealthPolicy Research Programme (PR-R11-0914-12003 Learning from leadership changes made by boards ofhospital NHS trusts and foundation trusts following the Francis Inquiry Report June 2015-June 2017). Theviews expressed in this report are those of the authors and not necessarily those of the Department of Health.To view the full report and the easy guide online please go to http://www.research.mbs.ac.uk/hsrc
AcknowledgementsThe study authors would like to thank colleagues from the NHS for taking time out of theirbusy roles to participate in scoping interviews, attend workshops and otherwise contribute tothe project. Additionally, we are grateful to the 381 NHS board members who completed thenational survey, often adding detailed and insightful comments. We would also like to thankstaff, patients and governors at the six case study sites for making us welcome, grantinginterviews, facilitating access to focus group discussions, signposting us to documents andobservations of meetings and receiving feedback arising out of our findings.The authors would like to pay tribute to Victoria Mansfield and Chris Mellingwood for theirconscientious and efficient administrative support. Specific thanks are also due to our teamof advisory group members.Advisory Group membersCatherine White (Chair), Patient and Public RepresentativeDebby Lennard, Patient and Public RepresentativeFrancesco Palma, Patient and Public RepresentativeRosemary Whitehurst, Patient and Public RepresentativeChris Cornforth, Open University Business SchoolJocelyn Cornwell, Point of Care FoundationBill Gregory, Lancashire Care NHS Foundation TrustPeter Jones, EvershedsLorna McKee, University of Aberdeen Business SchoolTerry McNulty, University of LiverpoolRod Sheaff, University of PlymouthJohn Storey, The Open University Business School1
Index of contentsAcknowledgements . 1Advisory Group members . 1List of appendices . 7List of boxes . 8List of figures . 8List of tables . 9Alphabetical list of abbreviations . 11Executive summary. 12Background . 12Study aims . 12Methods . 13Patient and public involvement in the research . 13Equality and diversity. 14Key findings . 14Implications of results for policy . 16Conclusions and areas for future research. 16Dissemination . 1812Introduction . 191.1The aim of this study . 191.2Research objectives . 201.3The scope of the study. 211.4The structure of this report . 22Background and policy context . 232.1Introduction . 232.2The road to 2013: the first Francis Report and other inquiries into Mid StaffordshireNHS Trust . 24The 2010 Francis Inquiry: the ‘first Francis Report’ . 262.3The 2013 Francis Inquiry Report . 27Main themes in the 2013 Francis Report for acute trusts . 28Fundamental standards . 28Openness, transparency and candour. 293
Nursing standards . 30Patient-centred leadership. 30Information . 312.4The government response to the 2013 Francis Inquiry Report . 31Impact of Francis on the CQC: Inspection and enforcement . 32Well-Led . 33Special measures. 33Duty of Candour . 34Fit and Proper Person Test. 35Parallel initiatives to improve quality and safety of care . 3532.5Changes in the financial context facing acute trusts since 2013 . 382.6Changes in the policy landscape since 2013 . 402.7The Five Year Forward View and STPs . 412.8Conclusion. 42Methodology. 443.1Theoretical overview . 443.2Research design . 463.3Work package 1: Scoping phase . 493.4Work package 2: National survey of NHS board members of general and specialistacute trusts in England . 503.5Work package 3: Case studies of hospital trusts and foundation trusts . 513.6Work package 4: Synthesis of findings and production of recommendations . 533.7Patient and public involvement, the role of the advisory group and the contributionsmade by the stakeholder workshops to the research . 543.84Research governance arrangements . 55Characteristics of effective NHS boards: updated literature review and accounts ofstakeholders. 564.1Introduction . 564.2Summaries of two recent reviews . 564.3Themes from updated literature review . 61Board purpose . 614
Board composition . 62Board focus on setting and tracking the strategic direction . 63Board focus on monitoring of clinical quality of care . 63Board dynamics . 64Summary of new conceptions about the work of healthcare boards . 654.4Accounts of opinion leaders . 66Main concerns of boards. 66Desired characteristics of healthcare board leadership. 67Actions that boards were expected to take after Francis . 68Current realities for boards . 68Common board behaviours . 69Levers for change . 69Concluding remarks . 705National survey of board members and secretaries . 725.1Purpose and scope . 725.2Respondents . 735.3Findings . 74The role of the board: emphases placed on different purposes . 74Challenges reported by boards . 77Board member knowledge of what is important to patients, staff and regulators . 81Implementation and impact of the Francis Report recommendations . 825.4Implementation and impact of the Fit and Proper Persons Requirement . 975.5Implementation and impact of the Freedom to Speak Up Guardian . 995.6Impact of the Duty
Responses to Francis: changes in board leadership and governance in acute hospitals in England since 2013 Full Report Version January 2018 List of contributors:Cited by: 1Publish Year: 2018Author: Naomi Chambers, Ruth Thorlby, Alan Boyd, Judith Smith, Nathan Proudlove, Hannah Kendrick, Russell Ma.
