Final Report > Chapter 27: Care of an Appropriate Standard > Generic standards for healthcare organisations > Validation of services or facilities within a trust

Validation of services or facilities within a trust

42 We also see considerable benefit to patients in taking a further step, by extending the process of validation of trusts to cover discrete, identifiable services within a trust. This will involve setting or developing existing standards for those services. In some circumstances it would be appropriate for the standards to focus on a particular set of clinical conditions, for example, services for people with cancer, or services for children with congenital heart disease. In other circumstances, the standards could focus on a particular facility within the hospital, such as the accident and emergency service, or the day surgery service. Thus, a local hospital or a primary care trust might be granted validation to provide day surgery, but not major acute surgery. It might be granted validation to run a minor injuries unit but not a major accident and emergency department. A large acute hospital might be granted validation to provide services designated as specialist services. One crucial consequence of this approach is that a hospital would not be able to offer a new service unless it met the standards necessary for validation. It would not be acceptable for a trust to aim to develop the service so as to be able to meet the standards at some point in the future. Moreover, by offering a service to the public which was not validated, chief executives would be in breach of their duty to ensure the quality of the services offered.

43 This process of validation would have very significant consequences for patients and their carers and families. To take the example of children's acute hospital services, parents in the future would know that a given hospital had received national validation to provide inpatient facilities for children, and thus that the hospital met the national standards on staff trained in paediatric care; suitable facilities for children; and child- and family-centred care. Thus they would know that the hospital had been validated to undertake paediatric surgery. They would know that the hospital had been validated to provide paediatric intensive care. Moreover, since the standards would be a matter of public knowledge, the public would know the standards to be expected. The public nature of the standards and the link to validation, which would be known to all those who work in and use the service, will act as a powerful and continuing incentive to maintain the standards. Validation of healthcare organisations would also be significant for the healthcare professionals. It would constitute an independent and public affirmation of the service of which they were a part.

44 We recognise that, in this as in any form of regulation, there will be costs as well as benefits. The costs of extending the process of validation to specific services are difficult to determine in the abstract. They will depend on the way the system is implemented. We believe that in time the benefits, in terms of the quality of care for patients, of there being nationally stipulated standards and a system of validation, will outweigh any direct costs. And there could be savings from better co-ordination and a rationalisation of the various inspections which trusts currently undergo. We recognise, however, that there is a case for proceeding carefully. We do not therefore suggest that a system of validating particular services be introduced all at once across the country. This would be to invite the sort of chaos which has dogged numerous other initiatives. Rather we urge that approaches to the validation of specific services be developed, piloted and evaluated, prior to their implementation on a national scale. Children's acute hospital services in general, and paediatric cardiac surgery in particular, should, we believe, be included in any pilot. Should the pilot be successful, the category of discrete service which should be a priority for this form of validation are those specialist services which are currently funded by, or meet the criteria for funding, set by the National Specialist Commissioning Advisory Group (NSCAG), the successor body to the Supra Regional Services Advisory Group (SRSAG).