Recommendation 24

Clarity over compliance with fundamental standards

Accepted
Compliance with regulatory fundamental standards must be capable so far as possible of being assessed by measures which are understood and accepted by the public and healthcare professionals.

The Care Quality Commission has consulted on fundamental standards of care, which the Department of Health will reflect in regulations. The Care Quality Commission will engage with the public, providers and professionals to develop guidance that makes clear what it will take into account when enforcing the regulations, and prepare a handbook on how it awards ratings.

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. The consultation engaged 5,154 individuals and 4,500 organisations, and held 41 consultation events. 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 of Health will shortly consult on the draft regulations; these will set in legislation the fundamental standards of care as outcomes that must be avoided; they will also streamline and improve the clarity of requirements that must be positively achieved in order for a provider to register with the Care Quality Commission (these requirements were called ‘expected standards’ in its consultation). Subject to Parliament, the regulations will come into force during 2014.

While the focus is on hospital services in the first instance, in October 2013 new Chief Inspectors of General Practice and Adult Social Care took up post in the Care Quality Commission, and it will extend and develop guidance on the regulations for providers into all three of the Chief Inspectors’ respective sectors. The Deputy Chief Inspector of Mental Health will report to the Chief Inspector of Hospitals on how this applies to mental health services.

The three Chief Inspectors will engage the public, professionals and providers in developing guidance for all sectors. Attention will be given to how the fundamental standards of care are presented to the public, in particular so as to clarify the relationship to rights under the NHS Constitution and consumer rights.

Many of the fundamental standards of care will include human rights dimensions, for example, subject to parliamentary approval, they will confer a duty on providers to, among other things, treat people with dignity and respect, protect them from abuse, involve them in their care, and look after their care and welfare.   The fact that fundamental standards of care will cover issues also protected by human rights means that patients and other service users will have additional protection to that which already exists under equality legislation and the Human Rights Act 1998.

Update

Between April and June 2014, the Care Quality Commission consulted on how it planned to change the way it regulates, inspects and rates care services. As part of this, it carried out 36 consultation events, hearing from over 700 people including members of the public, organisations that represent people who use services, providers, commissioners and staff. It received over 400 responses through its online web form and just under 200 written responses

The outcome of this consultation was the publication of a series of new provider handbooks describing the end to end inspection process, including how the Care Quality Commission will judge what good quality care looks like and how it will rate providers. These handbooks cover hospitals, specialist mental health services, community health services, adult social care and GPs and out of hours services.

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 the 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 into force in November 2014.

In July 2014, the Care Quality Commission consulted providers, health care professionals and other key stakeholders on proposed guidance on meeting new fundamental standards regulations. The Care Quality Commission has published final guidance on how organisations may comply with the duty of candour and the fit and proper person requirement for NHS bodies which came into force in November 2014. The Care Quality Commission will publish guidance on meet the remaining fundamental standards prior to them coming into force in April 2015.