Final Report > Chapter 21: Introduction > Guiding principles underlying our approach and recommendations > A comprehensive approach to quality with safety as the foundation

A comprehensive approach to quality with safety as the foundation

14 We are convinced that the only definition of quality in the context of healthcare which can be of real value has to be one which is all-embracing. A first condition for achieving quality in healthcare is that the service is safe. Once safety, as a fundamental prerequisite, has been addressed, attention must turn to the pursuit of quality. In essence, this involves identifying what will enable the NHS to meet its own high objectives and values. For us, this translates into the following concrete requirements. The quality of healthcare can only meet levels of which the NHS can be proud, if healthcare first encompasses the notions of respect for and honesty towards patients. It must recognise the emotional as well as the physical needs of patients (and their families). It must be delivered by competent staff who have suitable facilities and are always striving for improvement. It must be informed by up-to-date medical knowledge, including mechanisms for assessing the effectiveness and value of treatment. It must be safe, avoiding error and accident as far as is possible. It must be appropriate for and responsive to the needs of the patient, including being available when needed, in good time and accessible. Finally, responsiblity for the quality of healthcare services must rest with some identifiable person. That person now is the chief executive of each trust. [9]

15 A particular feature in our approach should be noted. Traditionally, analyses of the quality of healthcare have concentrated largely on the skills of the healthcare professionals who work in the NHS. More recently, attention has turned to the systems by which healthcare is delivered, focusing on such systems as those concerned with safety, standards, and the `pathway'of patients' care as they move between GP and hospital. We go further. We are also concerned with the attitudes which those in the NHS bring to their work: how they relate to and respect the interests of patients. We are saying, in effect, that to secure care of high quality across the NHS, we can no longer overlook those elements of the service which go beyond technical skills and competence and beyond the systems in which they are practised. We have to care about attitudes, about respect and honesty, indeed about a partnership between patients and professionals.

Footnotes

[9] Throughout we use the word `trust' to refer to an NHS acute hospital or healthcare trust. We do not intend it to refer to any other type of trust. Whenever we wish also to include primary care trusts we specifically say so