Final Report: Recent developments

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Final Report > Chapter 27: Care of an Appropriate Standard > Recent developments

Recent developments

11 It is now widely accepted that this state of affairs has to change. Patients are entitled to expect that their care will be of such quality as is consonant with good practice, based on sound evidence. To adopt the words of the White Paper `A First Class Service': `High quality services should be available to all patients. At present, there are unacceptable variations in the quality of care available to different NHS patients in different parts of the country. This has to change'. [7]

12 A number of recent developments suggest room for guarded optimism for the future. The first is that, with an injection of funds into the NHS, attention can begin to move beyond issues of cost and efficiency to embrace more fully the issues of the quality of care. We say again, however, that without a continued increase in funding, progress along the lines which we propose will simply not be sustainable. Second, to signal the importance of quality and standards, the Government, for the first time in 1999, placed on trusts and health authorities a statutory duty to establish and maintain arrangements for monitoring and improving the quality of healthcare. Clearly, if the chief executive of a trust is legally responsible, and publicly accountable for making something happen, the odds of its happening improve. Third, Government has made it clear that it will set national standards for clinical care in the form of clinical guidelines developed by the National Institute for Clinical Excellence (NICE), and through National Service Frameworks (NSFs) developed by the DoH. Fourth, initiatives are in hand to monitor performance. The Commission for Health Improvement (CHI) is required to inspect each trust every four years to review clinical governance arrangements. [8] In addition, part of CHI's work will be to undertake a programme of reviews to see how well the guidelines developed by NICE and the NSFs are being implemented. Further, CHI with the Audit Commission will jointly publish information annually on the performance of the NHS, including performance against a selected number of clinical indicators, such as rates of survival from different forms of cancer. Such initiatives represent a start, albeit belated, on the road to understanding and then improving quality of care.


Box A - Current arrangements for setting national standards of care Clinical Guidelines from the National Institute for Clinical Excellence (NICE) NICE is a Special Health Authority for England and Wales. It is part of the NHS. Its role is to provide patients, healthcare professionals and the public with authoritative, robust and reliable guidance on current `best practice'. Its guidance refers both to particular technologies in healthcare (medicines, medical devices, diagnostic techniques and procedures) and the clinical management of specific conditions. One of the four main strands of NICE's work is to set `clinical guidelines for clinicians and patients'. Around 20 topics are addressed annually. A list of topics is set and agreed annually by the Secretary of State for Health and by the Welsh Assembly. A long-term objective identified by NICE is to achieve a full description of clinical practice. Source: www.nice.org.uk National Service Frameworks (NSFs) from the Department of Health NSFs were first announced by the Government in the White Paper `The New NHS' (1997). NSFs set national standards and define service models for a specific service or care group. They aim to put in place programmes to support implementation of the standards and to establish performance measures against which progress within an agreed timescale can be measured. The first two `Frameworks' were the Paediatric Intensive Care Framework and the Calman-Hine report on Cancer Services. Three more are in place: Mental Health (1999); Coronary Heart Disease (2000); and Care of Older People (2001). Others, in preparation, include: Care of People with Diabetes, to be published later this year (2001); and one for Children's Health Services. When NSFs are written they include some clinical performance indicators which can be used to monitor implementation of the framework. The Department of Health develops each NSF with assistance of an expert group of health professionals, service users and carers, health service managers, and other relevant bodies. Sources: NHS Plan 2000, www.doh.gov.uk

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Footnotes

[7] Department of Health. `A First Class Service; Quality in the New NHS'. London: The Stationery Office, 1998

[8] According to CHI: `Clinical governance comprises the clinical and managerial systems, procedures and working practices that NHS organisations should have in place to ensure that patients receive the best possible care.' For background to clinical governance reviews see: www.chi.nhs.uk. Examples of systems which form part of clinical governance arrangements include clinical audit, risk management and the arrangements for staffing and staff management