A continuing focus on hospital hygiene and safety, “systematic” measurement and publication of data for the first time on the care quality available at different hospitals, and strengthened rights for patients to choose their location and mode of treatment, with more information to aid “informed choices”, are among the new measures set out in the NHS Next Stage Review Final Report – “High Quality Care For All”.
The report was formulated after a 12-month review which gauged the views of 60,000 patients, public and staff on the key priorities for the NHS for the next decade and beyond. It was published, in the same week that the NHS celebrated its 60th birthday, alongside a new draft NHS Constitution (out for consultation until 18 October), which Health Secretary Alan Johnson said “reaffirmed the rights to NHS services, free of charge without discrimination of any kind, bringing together for the first time in one place, and clarifying for staff and patients, their rights and responsibilities to ensure the NHS operates fairly and effectively”. The Constitution would “put privacy, dignity and cleanliness at the heart of care”, with tough new enforcement powers to tackle, for example, healthcare infections, and a “checklist” for all hospitals to reduce catheter-induced infections.
While “High Quality Care For All” focuses significantly on measures to improve clinical care standards, plans likely to be of particular interest to estates and facilities personnel include:
• For the first time, there will be “systematic measurement” of, and publication of information on, the quality of care, “from the frontline up”. From 10 April, 2010 all registered healthcare providers working for, or on behalf of, the NHS, will, by law, have to publish “Quality Accounts”. The new Care Quality Commission (CQC) will independently validate provider and commissioner performance, using quality indicators agreed nationally with the Department of Health, and publish an assessment of comparative performance
• Making funding for hospitals treating NHS patients “reflect the quality of care that patients receive”, with patients' own assessments of their treatment and “quality of experience” directly impacting.
• New enforcement powers for the Care Quality Commission, with further emphasis on improving hospital safety and hygiene and reducing healthcare-associated infections.
• Development of new “best practice tariffs” focused on “areas for improvement”. The tariffs will “pay for best practice rather than average cost, meaning NHS organisations will need to improve to keep up”.
• All patients will have a right to see the information held about them.
• All staff will have access to a new NHS Evidence web portal, providing authoritative clinical and non-clinical evidence and best practice.
• New pledges to staff, under the NHS Constitution, on “work and wellbeing”, learning and development, and “involvement and partnership”.
• Strengthened arrangements to ensure staff have “consistent and equitable” opportunities to update and develop skills.
Lord Darzi said the review had revealed support “from every corner of the NHS” for a continuing strong focus on patient safety. To this end, the new health and adult social care regulator, the Care Quality Commission (CQC), will be able to use its new enforcement powers in relation to infections from April 2009 (a full year before the new powers will be available to it in respect of other quality and safety requirements). The CQC will have a “stronger focus on compliance” and “more flexible enforcement powers”.
The report also makes clear the healthcare sector must improve the accessibility and quality of information available to patients. To better inform them about the care standards at different locations, Trusts will have, in future, to provide online “easy-to-understand, service-specific comparable information on every aspect of high quality care” – including cleanliness and infection rates; “satisfaction”, “dignity and respect”.
The NHS Constitution will “guarantee” that this information will be “freely and openly available, and reliable”. Payments to hospitals will be “conditional” on both the quality and volume of care provided, with “quality metrics”, including cleanliness and infection rates, clinical outcomes, and patient experience against key quality indicators, used to determine the sums paid out.
The report also stresses the increasing emphasis on providing convenient care closer to people’s homes, and of harnessing new “assistive” and remote monitoring technologies to help patients lead independent lives.
Lord Darzi said: "This report will enable frontline doctors, nurses and patients to put into practice their visions for high quality care. As a surgeon I know how vital it is to balance the quality of the patient's experience – a clean and safe environment, being treated with compassion dignity and respect – with the success of the treatment they receive.
"By measuring this quality across the service and publishing that information for the first time, staff and patients can work together to make better informed choices about their care. By setting clearer standards, and recognising and rewarding innovation in quality, we can keep pace with the latest advances in medicine and technology.”
* The NHS Next Stage Review – “High Quality for All”, and the new draft NHS Constitution, can be viewed at: www.ournhs.nhs.uk
