The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [120]
The reforms in monitoring risk and safety in the NHS at this time involved working in partnership with the public, nurses, doctors and allied healthcare professionals. The government, however, made it clear that the responsibility for managing risk and quality lay with the individual staff and professions within the NHS, and ‘failure would not be tolerated’ (DH 1998).
The quality agenda
The quality agenda has been a key driving force in the development and funding of health services in the new millennium. Nurses, doctors and allied healthcare professionals (AHPs) need to demonstrate that they are not only managing risk and preventing harm, but that they are also achieving key clinical outcomes for their patients. The increase in regulation of health services, in the form of clinical audit, professional peer review and external regulation, and the sharing of this information with the public have enabled patients to make choices regarding the treatment and care they receive. Nurses now find themselves in the position of explaining to patients how they are ensuring their safety, particularly with issues such as hand hygiene and cleanliness.
As with all public services, regulatory oversight of the NHS has increased notably since the 1980s. It is conducted at arm’s length from the government through a number of external bodies (Power 2007).
Hutter (2006) summarized this trend as a move from government to governance. High Quality Care for All (DH 2008), the final report of the Next Stage Review, was a landmark document for the future of healthcare in the UK. In the report, Lord Darzi described quality as having three key components in relation to doing the best for patients: patient experience, effectiveness of care and patient safety, or, from a patient’s viewpoint:
be nice to me
make me better
do me no harm.
Table 4.1 outlines Darzi’s seven steps to quality, all of which relate to staff throughout the NHS, from those in the clinical areas delivering hands-on care to the leaders of organizations at trust board level.
Table 4.1 Darzi’s seven steps to enhancing quality
Step Enhancing and improving quality Description
1 Bring clarity to quality Further development of NICE and evidence portal
2 Measuring quality The introduction of quality metrics and ‘scorecards’ to demonstrate quality performance against quality targets
3 Publish quality performance As from April 2010, all NHS and Foundation trusts are obliged to publish quality accounts. These demonstrate how the above measures of quality have been achieved and the quality objectives for the organization
4 Recognize and reward quality Commissioning for Quality and Innovation (CQUINS) provide financial incentives in relation to preset quality indicators
5 Raise standards A National Quality Board and Quality Observatory will ensure quality standards are set and met within the health service
6 Safeguard quality From 1 April 2009 healthcare organizations were obliged to register with the newly formed CQC regarding compliance with the Hygiene Code and from 1 April 2010 regarding compliance with the Quality Standards for Health
7 Staying ahead Professionals are encouraged to introduce best practice models from the UK and abroad
Care Quality Commission (CQC)
The CQC was established by the Health and Social Care Act 2008 to bring together the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission, the three former regulatory bodies in the health and adult social care system in England. The creation of a super-agency is intended to overcome barriers between health and social care where the distinctions