Final Report > Chapter 27: Care of an Appropriate Standard > Recent developments > Insufficient co-ordination in setting standards

Insufficient co-ordination in setting standards

14 As we mentioned previously, many of the Royal Colleges and specialist professional organisations since the late 1980s, have issued, intermittently, standards and guidance for the treatment of a range of conditions. In the last two to three years, probably in response to the widely acknowledged vacuum in this area, this work has intensified. We list here a few examples. The Royal College of Nursing told us that its current work `... includes setting national standards and clinical guidelines ...'. [9] The Royal College of Physicians, through what is now its Clinical Effectiveness and Evaluation Unit, has since 1990 produced guidelines for the care and treatment of over 90 conditions. In the particular clinical areas which are of interest to this Inquiry, the Royal College of Surgeons of England recently issued guidance on children's surgery; [10] and, with regard to the removal and retention of human material, the Royal College of Pathologists issued guidance in 2000, only to be followed by the BMA and the DoH, each with its own guidance on the same topic.

15 There is much to be welcomed here, not least the preparedness of the Royal Colleges and other bodies to seek to fill the previous vacuum. But there are also disadvantages in the appearance of a host of guidelines from different bodies, some, indeed, on the same subject. Trusts and healthcare professionals may not know which standards should be followed, or what status or authority the standards have. Furthermore, patients do not know what to expect or what they are entitled to. Indeed, if patients with a particular condition were to seek to refer to the guidelines which relate to the care of their condition they might find several, aimed at different specialists, emanating from different Royal Colleges and professional associations. Equally, they might also find standards developed by local clinicians, or by the DoH, or possibly by NICE. Or, they might find none at all. It has to be said also that there is frustration on the part of the Royal Colleges and professional associations, as we heard during Phase One that, where they have developed standards, they have no means of ensuring compliance. The written evidence of Dr Michael Godman, then President of the British Paediatric Cardiac Association, was typical: `It is clear, however, that there is at present a vacuum in relation to the enforcement of standards. The Royal Colleges are primarily concerned with training and neither the Department of Health nor Purchasers/Commissioners for Services have set clearly defined standards by which centres can be judged.' [11]

16 There is also the potential for confusion if NSFs are written so as to include particular clinical standards other than those developed under the auspices of NICE. NSFs are laid down by the DoH. We have already referred to what we regard as an essential role of the DoH: to be the headquarters of the NHS. It is entirely compatible with this role that the DoH should seek to lay down NSFs, if Frameworks mean addressing broad issues concerning priorities, the effective use of resources, and the organisation of care. But it should not be part of the DoH's role also to seek to set standards for clinical care, whether as part of NSFs or not. If it does so, it goes beyond what we regard as its proper role. It adds to the confusion as to which standards apply if they should appear in an NSF and be issued by NICE. It also undermines the role of NICE as the body charged with setting standards. We recognise that the new arrangements introduced in 1999 are still, to a degree, bedding down. But, in relation to NSFs, we take the view that it should be the role of NICE to establish the detailed clinical standards which patients are entitled to expect, and thereby lend substance to these Frameworks.

Footnotes

[9] Seminar 6. The Royal College of Nursing. Position Paper

[10] The Royal College of Surgeons of England. `Children's Surgery - A First Class Service'. London, May 2000

[11] WIT 0047 0005 Dr Godman