Final Report > Chapter 27: Care of an Appropriate Standard > Generic standards for healthcare organisations

Generic standards for healthcare organisations

31 We note that in Scotland the standards set by the Clinical Standards Board include what are described as generic standards, that is, standards which are addressed to the hospital as a whole. These are distinct from standards which focus on the care and treatment of patients with a particular illness or condition. We have already observed that, in relation to Bristol, the standard of care was significantly influenced by factors which were not specific to the healthcare professionals, were generic to the hospital as a whole. For example, the state of the buildings and of equipment, the quality of the leadership, and the Trust's policies and procedures all had an impact on the adequacy of care for children with congenital heart disease. It was the healthcare organisation, as much as (or more than) the healthcare professionals, which caused the problems. This leads us to the view that there needs to be increasing rigour in preventing trusts from continuing to offer a clinical service (or services) when the service falls below the agreed standards and is consistently less than adequate. Professor Mike Richards, the Government's National Cancer Director, addressed this very point when launching the `Manual of Cancer Services' in 2001. He said: `The public want to know that the service they are getting is a good one. If a hospital is way off the standard we want, should we be having patients dealt with by that sort of service? The answer must be no ...' [20] We believe this is fundamentally the right approach. We would add that, in practice, should matters so deteriorate and not be capable of rapid improvement, this would mean the suspension or closure of services, and the re-provision of the service in another hospital. Clearly such drastic action and all the consequent upheaval it would produce would be very much the last straw. In particular, it must not mean that a poor service is starved of resources so that it gradually `withers on the vine' and patients suffer ever diminishing standards. Support, not sanctions, is the preferred approach. We explain, later on, the wider system which we believe should be put in place to give effect to this approach.

32 We have made it clear earlier (Chapter 25 - The Competence of Healthcare Professionals) that the process of validating and revalidating healthcare professionals as being competent to do their job is an important component of ensuring the safety and quality of healthcare. In the future all healthcare professionals will be expected to participate in such a process. In our view, it is equally important that trusts, including primary care trusts, also participate in a formal process of validation and revalidation, a process which is of a different order from, but in parallel with, that which healthcare professionals will undergo. We choose the term `validation' not only to mirror the process recommended for healthcare professionals but also to indicate that while akin to licensing it contemplates more. Licensing tends to be thought of as a `one-off' event, whereas to us validation is a process. What makes validation akin to licensing is the element of permission to continue.

33 The analogy of the airline industry is instructive. It provides a service of potentially high risk. All elements of the industry are subject to standards for safety and quality which are monitored. While the competence of individual airline employees is regularly checked and revalidated, and the airworthiness of aeroplanes is frequently checked, the airline company itself must also seek certification from the regulatory body to entitle it to operate an air service. Thus the individuals who operate the service, the equipment they use, and the organisation which provides the service are all subject to a form of external regulation.

Footnotes

[20] Charter, D. `Red Tape row over cancer treatment'. `The Times', 19 Jan 2001