Final Report > Chapter 27: Care of an Appropriate Standard > Setting standards for clinical care

Setting standards for clinical care

26 We have already argued that the emergence of a variety of standards of clinical care from a variety of organisations, while it shows a willingness to become involved, may produce more confusion than clarity. One of the themes of Bristol was that, while a large number of organisations were involved in one way or another in paediatric cardiac surgery, each thought the other was looking after the matter of standards (and, to a degree, performance in relation to those standards), such that the concern for quality fell through the cracks between the various organisations. [17] That lesson from Bristol leaves us in no doubt that there must be some body or organisation which takes overarching responsibility for the setting of standards. This does not mean that this body itself should necessarily draft the standards, only that it is there to see that they are developed, agreed and kept up to date.

27 The organisation best suited to do this is NICE. It already has authority from the Secretary of State to develop clinical guidelines which can form the basis of, and embrace, standards. If required, it would have to be given any necessary additional statutory authority to develop and manage a programme of setting standards, along with the necessary additional resources. In turn, NICE must engage and make full use of the expertise of relevant organisations such as the Royal Colleges and the specialist professional associations. It must draw on the expertise of senior management in the NHS. It must also fully engage the public, patients and carers, as indeed it is seeking to do. The principle would be that of the hub and spokes. The hub would be NICE. It would have overall responsibility and be accountable. The spokes would be the contributing elements: the Royal Colleges, the specialist professional associations, the public and the NHS. In this way, standards would be co-ordinated and managed across the whole of healthcare. It would spell the end to the cottage industry of various bodies developing standards for the NHS and issuing them independently. There will be one authoritative organisation, NICE, under whose aegis all standards for the care provided by the NHS would be issued. All such standards should be made public.

Footnotes

[17] See Annex A Chapters 4 and 20-31