Safeguarding

16 chapter 2 The Wider Context
Chapter 2
The Wider Context
Quality standards and the regulation of healthcare organisations
2.1 The 1998 consultation paper A first class service 14 set out a broad strategy for promoting clinical
quality in the NHS. The strategy comprises three interlocking components:
• explicit standards describing the quality of care which patients can expect to receive;
• assurance of, and continuous improvement in, the systems and processes for local delivery
of healthcare through clinical governance; and
• national monitoring of performance in relation to the standards.
2.2 Quality standards relating to individual services or interventions are published in guidance
documents from the National Institute for Health and Clinical Excellence (NICE) and in National
Service Frameworks. Generic quality standards for the NHS (“Standards for better health”) were
set out in National standards, local action 15 in seven “domains”, including patient safety, clinical
effectiveness and governance (see below). Within each domain, the standards are divided into
core standards which all NHS organisations are expected to achieve, and developmental
standards which are to be achieved over a period and provide a framework for continuous
improvement in quality.
2.3 Responsibility for the assessment of NHS primary care trusts (PCTs) and specialist services
rests with the Healthcare Commission, whose remit largely derives from the recommendations of
the Bristol Royal Infirmary Inquiry 16 . Each year the Healthcare Commission publishes its assessment
of the performance of all NHS organisations against each of the standards, leading to an overall
rating based on the balance of performance across all seven domains.
2.4 Healthcare providers in the independent and voluntary sectors are assessed against regulations
issued under the Care Standards Act 2000 and underpinned by a different set of standards, the
National Minimum Standards 17 ; compliance with these regulations is a precondition of registration
by the Healthcare Commission (for hospitals and clinics) or by the Commission for Social Care
Inspection (for care homes). The Department intends in the near future to amend the regulations
and National Minimum Standards to align them with the Standards for better health, so that all
healthcare organisations can be assessed on the same basis.
2.5 More fundamental changes to the regulation of healthcare organisations were recently
announced in The future regulation of health and adult social care in England 18 . This document
proposes that, with effect from 2009-10, all healthcare providers in secondary care, including NHS
providers, should be included within an integrated registration regime and assessed against
national standards of quality and safety. Organisations failing to give assurance that they are