Progress on the introduction of supervisory ward manager roles since the Francis report recommendations

In 2010 the Secretary of State for Health, Andrew Lansley, announced a public inquiry into the events at Mid Staffordshire NHS Foundation Trust. The inquiry and the subsequent report (Francis, 2013a; 2013b; 2013c; 2013d) found systematic failings, neglect, bullying and poor quality care and leadership within the Trust. In particular, the Secretary of State suggested it was not only a failing of the Trust, but a national failing ‘of the regulatory and supervisory system’ (2013a, section 12: 9) and he questioned why the failings at the Trust had only surfaced due to the determined action of families to expose them. The Francis report summary (2013a) identified 290 recommendations. Recommendation 195 suggested that nurse leadership could be improved if ward and nurse managers worked in a supervisory capacity, were not office bound and were involved in supervising patient care plans while not being rostered (supernumerary) to care (Francis, 2013a: 106) (Box 1). Other recommendations suggested giving nurses recognition for their commitment to patient care and acquiring leadership skills (recommendation 196) and commissioning arrangements to ensure leadership training is available (recommendation 197) from students to directors (Box 1). However, there has been criticism that many Francis report recommendations, such as increasing staffing levels on wards, have been implemented only when they do not have resource implications for trusts (Mahony, 2014) due to a false economy perspective (Regan and Ball, 2017).