The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [13]
helps to prevent illness, and promotes healthy, independent living
is available to those who need it when they need it
provides good value for money.
(www.cqc.org.uk/aboutcqc/whoweare.cfm)
To make this happen the Care Quality Commission has been given statutory powers to enforce standards through prosecution of those statutorily accountable for quality in any healthcare organizations (not just the NHS). These regulatory duties are carried out in the acute care setting through the following pathways.
Registration and enforcement
The Health and Social Care Act, 2008 introduced a new, single registration system that applies to both health and adult social care. From April 2010, all care providers who provide regulated activities (see Box 1.1) will be required by law to be registered with the Care Quality Commission (www.cqc.org.uk/guidanceforprofessionals/introductiontoregistration/whoneedstoregister.cfm). To register, all healthcare providers must show they are meeting new essential standards of quality and safety across all the regulated activities they provide (see Box 1.1).
Box 1.1 Healthcare activities that need to be registered with the Care Quality Commission
Regulated activities that require registration are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2009. They include:
personal care
accommodation with nursing or personal care
accommodation for persons who require treatment for substance misuse
accommodation and nursing or personal care in the further education sector
treatment of disease, disorder or injury
assessment or medical treatment for persons detained under the Mental Health Act 1983
surgical procedures
diagnostic and screening procedures
management of supply of blood and blood-derived products
transport services, triage and medical advice provided remotely
maternity and midwifery services
termination of pregnancies
services in slimming clinics
nursing care
family planning services.
The list of regulated activities included in the regulations is based on the level of risk to people who use services.
(www.cqc.org.uk/guidanceforprofessionals/introductiontoregistration/whoneedstoregister.cfm#3)
The new system will make sure that people can expect services to meet essential standards of quality and safety that respect their dignity and protect their rights. The new system is focused on outcomes, rather than systems and processes, and places the views and experience of people who use services at the centre. The Care Quality Commission currently publishes results so they are in the public domain. Information is expected to be available more regularly and speedily so that ‘Patients will have access to the information they want, to make choices about their care’ (DH 2010a, p.3).
Assessments of quality
To register, the CQC expects organizations to meet essential standards in quality and safety. Organizations are expected to produce evidence to demonstrate they have met outcomes relating to important aspects of care in respect of:
involvement and information
personalized care, treatment and support
safeguarding and safety
suitability of staffing
quality and management
suitability of management.
Publishing information
This information will then be made available to people so they can make informed decisions about where they have their care. This impacts on nursing as there is an expectation that procedures that define care given are explicit and of course followed.
Patient safety
A key patient safety issue that remains a priority for the NHS has been tackling healthcare-acquired infections. A variety of measures have been put into place following the catastrophic occurrence of deaths from Clostridium difficile and MRSA bacteraemias in 2004–5 (Healthcare Commission 2006, 2007).
Mandatory surveillance of C. difficile was introduced in 2004 (because it is a significant cause of morbidity and can be difficult to treat because of its multiple antibiotic resistance).
Agreed maximum numbers of MRSA bloodstream infections.