Final Report > Recommendations > Care of an appropriate standard > Standards of care: NHS organisations

Standards of care: NHS organisations

130. There must be a single, coherent, co-ordinated set of generic standards: that is, standards relating to the patient's experience and the systems for ensuring that care is safe and of good quality (for example corporate management, clinical governance, risk management, clinical audit, the management and support of staff, and the management of resources). Trusts must comply with these standards.
131. The current system of inspection of trusts and primary care trusts should be changed to become a system of validation [4] and periodic revalidation of these trusts. The system should be supportive and flexible. Its aim should be to promote continued improvement in the quality of care.
132. One body should be responsible for validating and re-validating NHS trusts and primary care trusts. This body should be CHI, suitably structured so as to give it the necessary independence and authority. Other bodies (for example the NHS Litigation Authority) which are currently concerned with setting and requiring compliance with those generic standards which should fall within the authority of CHI, should carry out their role in this respect under the authority of and answerable to CHI.
133. Validation and revalidation of trusts should be based upon compliance with the generic standards which relate to the patient's experience and the systems for ensuring that care is safe and of good quality.
134. The standards against which trusts are to be validated, and the results of the process of validation or revalidation, should be made public.
135. Any organisation in the voluntary or private sector which provides services to NHS patients should be required to meet the standards for systems, facilities and staff which organisations in the NHS must meet. The aim should be that, wherever care is funded by the NHS, there is a single system of validation which indicates to the public that the organisation meets the necessary standards.
136. The validating body should have the power to withdraw, withhold or suspend a trust's validation if standards fall such as to threaten the quality of care or the safety of patients. Any trust or organisation whose validation may be affected in this way must be given the opportunity to take appropriate remedial action. It must then satisfy CHI that it has taken remedial action before its continued validation can be confirmed.
137. CHI should consider how it might work with the providers of those programmes of accreditation already adopted by a significant number of trusts. In the future, where required standards are met, CHI should accept as part of its validation process the accreditation obtained through these programmes.
138. The process of validation of trusts should, in time, be extended to cover discrete, identifiable services within trusts. This extension of validation should first be piloted and evaluated.
139. The pilot exercise for this form of validation should include children's acute hospital services and paediatric cardiac surgery.
140. Should the pilot exercise be successful, the category of discrete services which should be a priority for this form of validation are those specialist services which are currently funded or meet the criteria for funding by the National Specialist Commissioning Group (the successor to the Supra Regional Services Advisory Group).
141. For discrete services, whether specialist services or otherwise, to be validated trusts they must be able to demonstrate that all relevant aspects of the service can currently be met, rather than that the trust aims to develop so as to be able to do so at some point in the future. Trusts which do not meet the necessary standards to ensure the safety of patients and a good quality of care should not be permitted to offer, or continue to offer, the relevant service.
142. Where the interests of securing quality of care and the safety of patients require that there be only a small number of centres offering a specialist service, the requirements of quality and safety should prevail over considerations of ease of access. It is and should be the responsibility of the NHS to assist patients, and their families or carers, with the cost of transport and accommodation when they have to travel away from home to receive specialist services. Such support should not be the subject of a means test. (See further Recommendations 181 and 182 on specialist services for children.)

Footnotes

[4] We choose the term `validation' not only to mirror the process which healthcare professionals will have to undergo, 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