Recommendation 11

Compliance with standard procedures

Accepted
Healthcare professionals should be prepared to contribute to the development of, and comply with, standard procedures in the areas in which they work. Their managers need to ensure that their employees comply with these requirements. Staff members affected by professional disagreement about procedures must be required to take the necessary corrective action, working with their medical or nursing director or line manager within the trust, with external support where necessary. Professional bodies should work on devising evidence-based standard procedures for as many interventions and pathways as possible.

Where there is good evidence that standardised procedures minimise risk and promote safer care, then it is the responsibility of healthcare staff to comply with these. Healthcare professionals are obliged by their professional code of conduct to comply with local standardised procedures and employers and line managers should take responsibility for addressing non-compliance.

The Department of Health is drawing up a new set of fundamental standards of care that will sit within the legal requirements that providers of health and adult social care must meet to be registered with Care Quality Commission. Fundamentals of care will be set out in regulations, supplemented by guidance about compliance developed by the Care Quality Commission, and will also signpost guidance produced by the National Institute for Health and Care Excellence and others. Many of the fundamental standards of care will include human rights dimensions, for example, they will (subject to Parliamentary approval) confer on providers a duty 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 mean that patients and other service users will have additional protection to that which already exists under the Human Rights Act 1998 and equality legislation.

NHS England has agreed with the National Institute for Health and Care Excellence that the inquiry’s concept of enhanced standards will be in the form of the existing quality standards, which are developed by National Institute for Health and Care Excellence and endorsed by NHS England. Commissioners will be expected to ensure compliance with these.

In terms of input by professional bodies, the Academy of Royal Medical Colleges and Faculties have always taken an active leadership role in setting clinical service delivery standards. The Academy of Royal Medical Colleges and Faculties is working with the Care Quality Commission and the National Institute for Health and Care Excellence on how professional bodies will contribute to the development of standards and compliance measures and through this work, the Academy of Royal Medical Colleges and Faculties will make a significant contribution to consistency of patient experience, patient safety and clinical efficiency.

Update

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, Care Quality Commission consulted providers, health care professionals and other key stakeholders on proposed guidance on meeting the new 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 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.

The Care Quality Commission has been working with healthcare professionals including the Royal Colleges and their faculties, as well as providers, the public and other stakeholders throughout the development of its new regulatory approach. This has included:

  • engagement in the development of the Care Quality Commission’ s new approach to monitoring, inspecting and rating services and guidance on new regulations and enforcement powers;
  • identification of healthcare professionals to participate in the Care Quality Commission’s inspections;
  • support for the Care Quality Commission’s work on the use of clinical service accreditation schemes;
  • commitment to working together through the development of memoranda of understanding, joint working statements and information sharing agreements.