Recommendation 13

A range of safety and quality standards

Accepted

Standards should be divided into:

  • fundamental standards of minimum safety and quality – in respect of which non-compliance should not be tolerated. Failures leading to death or serious harm should remain offences for which prosecutions can be brought against organisations. There should be a defined set of duties to maintain and operate an effective system to ensure compliance
  • enhance quality standards – such standards could set requirements higher than the fundamental standards but be discretionary matters for commissioning and subject to availability of resources
  • developmental standards which set out longer term goals for providers – these would focus on improvements in effectiveness and are more likely to be the focus of commissioners and progressive provider leadership than the regulator

All such standards would require regular review and modification.

The Department of Health, the National Institute for Health and Care Excellence, NHS England and the Care Quality Commission are working on a new framework of standards.  New regulations setting out fundamental standards of care will come into effect during 2014, and will apply to all providers of health and social care required to register with the Care Quality Commission. Through its chief inspectors, the Care Quality Commission is engaging with providers, professionals and the public on what guidance it should publish on complying with these regulations and how they should relate to the Care Quality Commission’s broader assessments of the quality of health and care services.

In Patients First and Foremost the government confirmed that the Care Quality Commission would work with stakeholders to draw up a set of simpler fundamental standards that would make explicit the basic standards, and set a clear bar below which care should never fall. In June 2013, the Care Quality Commission issued A new start – Consultation on changes to the way CQC regulates, inspects and monitors care.  This document started the public discussion on what the fundamental standards of care should be. On 17 October 2013, the Care Quality Commission published the responses to the consultation in  A new start: Responses to our consultation on changes to the way CQC regulates, inspects and monitors care services, which showed that there is broad agreement with the new approach. The Department will consult shortly on the draft regulations; these will set in legislation the fundamental standards of care as outcomes that providers must meet.  The final set of standards is likely to cover areas such as: care and safety of patients and service users; abuse, including neglect; respecting and involving service users, nutrition; consent; governance; cleanliness and safety of premises and equipment; staffing; fitness of directors; and duty of candour.

The Care Quality Commission will issue succinct guidance on meeting the regulations’ requirements, which it will take into account when considering prosecutions. This guidance will sit alongside the broader handbook that the Care Quality Commission will issue on how it decides ratings of providers and services.

The fundamental standards of care will be part of the regulatory system in their own right, alongside the Care Quality Commission’s broader assessments of the overall quality of a provider’s services. This will start initially in the hospital sector, but also alongside new Chief Inspectors of General Practice and Adult Social Care, who will extend and develop the approach for their respective sectors over time. The Care Quality Commission will keep guidance for their sectors under review and will advise ministers if changes to the regulations are needed.

The National Institute for Health and Care Excellence has an existing programme of production of quality standards that define what high quality care should look like in a defined care or service area.  Topics in healthcare are referred by NHS England to the National Institute for Health and Care Excellence, and the National Institute for Health and Care Excellence provides guidance for commissioners to help them to commission for quality improvement within these areas. Enhanced quality standards are set out for commissioners in the National Institute for Health and Care Excellence quality standards, which in future will also specify developmental standards.

Update

The National Institute for Health and Care Excellence has introduced developmental statements in its quality standards where appropriate. Between June and September 2014 it published NICE quality standards – the process guide a consultation on its updated quality standards process guide which made detailed proposals for how developmental statements would be identified and produced.

The Government has passed legislation that will put in place new fundamental standards as requirements for registration with the Care Quality Commission. These fundamental standards set a minimum level below which care must not fall. Where providers fail to meet these standards the Care Quality Commission will be able to use its enforcement powers to protect patients and service users from the risks of poor care – including prosecuting providers where a failure to meet a fundamental standard results in avoidable harm to a patient or service user, or a significant risk of such harm.

The fundamental standards will come into force for all providers registered with the Care Quality Commission in April 2015. Two new regulations introducing a duty of candour for NHS bodies and a fit and proper person requirement for directors of NHS bodies came in to force in November 2014.The Care Quality Commission published guidance for providers on the duty of candour for NHS bodies and the fit and proper person requirement for directors of NHS bodies regulations to help providers meet the requirements of the regulations.

The Care Quality Commission has also recently published a series of provider handbooks. These will sit alongside the guidance on the regulations and describe the end to end inspection process, including how the Care Quality Commission will judge what good quality care looks like and how the Care Quality Commission will rate providers. The handbooks cover hospitals, specialist mental health services, community health services, adult social care, and GP and out of hours services.