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

A system for validating healthcare organisations

34 We see the need for a shift from the current notion of inspection of healthcare organisations in England towards one of validation. Inspection is a single event. It implies a `checking' mentality, and carries negative and punitive overtones. Validation, on the other hand, implies a constructive approach and a continuous process. We see it as a process with a clear aim: to help in the improvement of the quality of healthcare. It would include, but not be confined to, external assessment. The organisation itself would evaluate its own performance in the light of established standards, and be subject to external validation checks and visits. In what follows we set out how a system of validation of trusts would work.

35 The first stage in the process of validation is the setting of generic standards which will form an objective basis for assessment, and which all trusts must meet in order to be validated and thereby be entitled to provide NHS services. These standards will focus on matters such as the patient's experience and whether the trust is responsive to patients' needs. They will also address the trust's systems for ensuring that care is safe and of good quality (corporate management, clinical governance, risk management, clinical audit, the management and support of staff, and the management of resources). The basis for many of these standards in fact already exists, in one form or another, whether as legal requirements imposed on the trust, or in the form of guidance from the DoH and other bodies. Once translated into standards, we believe they should be obligatory. By this we mean that, unless the standards are met, the trust would not have the necessary validation. Periodically, each healthcare organisation in the country would receive a visit from external assessors to ensure that the standards were being complied with. (Sometimes, we believe, visits should be unannounced.) Thus, for example, the current routine visits by CHI would no longer be `inspections' but would become visits to validate a trust as suitable to offer NHS services. The system should be flexible. It would be a matter for CHI to determine how frequently it should visit a trust.

36 Compliance with the standards laid down on systems, facilities and staff, would mean that the trust would be granted validation and thus be entitled to offer NHS services. Ways might be explored to recognise circumstances where a trust exceeded the obligatory standards, or offered particularly good or exemplary service. The standards themselves, and the results of external assessment, will be made public and be easily accessible and visible throughout the trust and in the local community.

37 The validating body should adopt an approach which is flexible and seeks to support organisations. Its aim must be to promote continued improvements in the quality of care in the NHS. That said, however, it should have powers to act if standards fall such as to threaten the quality of care or the safety of patients. If any area of practice were to fall below the required standard, the organisation would be put on `validation watch'. An action plan and a timescale would be agreed for any problems to be remedied. If certain key areas of practice failed to improve, or fell significantly below the required standard, such as seriously to threaten the quality of care received by patients, it would remain open to the validating body to withhold, suspend, or even withdraw, validation.

38 We believe that the switch from a system of inspection to one of validation would further the overall direction of current policy. It would be achievable within the existing structure of CHI, but would take a change in emphasis and approach which we believe would be welcomed within the NHS and by the public.