Final Report > Chapter 6: Quality, Standards and Information > Responsibility for the quality of clinical care

Responsibility for the quality of clinical care

2 Responsibility for the quality of clinical care was regarded as lying with healthcare professionals, in the performance of their duties according to the standards of professional practice to which they had been educated and trained. Thus, for example, nurses sought to meet the standards of professional practice expected of them as nurses and doctors the professional standards expected of them as doctors. For healthcare professionals quality meant, as it always had, doing the best for the individual patient within the resources available, applying professional judgment to the particular patient's needs. There were no agreed standards as to what care the patient with a given illness or condition might expect of healthcare professionals as a team or of the NHS as a whole. There being no such standards, there were also no benchmarks against which to assess and evaluate the quality of clinical care given.

3 In this respect, health was no different at the time from most other public services employing professionals. In education and social care, for example, there were few, if any, national standards as to what a pupil or an elderly person could expect of the education or social services systems. Performance monitoring and a concern for the effectiveness of a service were only in their infancy. There was an unarticulated but, nevertheless, prevailing consensus which dominated thinking about public services up until at least the late 1980s: if enough well-qualified professionals could be educated and trained, they could then be relied upon to provide services of high quality throughout their working lives. Indeed, the prevailing wisdom was that policy-makers and managers should keep out of matters involving professional judgment. One such matter was the quality of the service delivered. That was the preserve of the professionals.