Quality assurance: the way forward

Many different healthcare organisations currently have and use frameworks for assessment, measurement and reporting mechanisms on the various dimensions of quality care, both within organisations and external to the providers. Many of the systems are overlapping and it is not always clear to clinicians how to report breaches in expected standards or to whom. Many of the current organisations to whom failings may be reported will be abolished in the new NHS and it is incumbent on everyone in healthcare to understand the new structures, reporting mechanisms and published standards. Failings reported by the Francis Inquiry into quality at the Mid Staffordshire Trust and more recently, the equally shocking findings at Winterbourne View show that we have not yet found the right framework for assuring quality of care. The long awaited final report from Robert Francis QC, has recently been delayed until after Christmas, and is widely expected to establish considerable (additional) change across the NHS. Meanwhile, the shadow National Quality Board has published a draft report which it will update in the light of the Francis Report recommendations, on the future shape of quality assurance within the new systems of care due in April next year.

Quality and standards

Lord D’Arzi established the vital component of quality in the last government’s Next Stage Review entitled High quality care for all published in 2008.1 In addition, he signalled the development and publication of the NH Constitution which puts quality and safety at the centre of healthcare delivery. The definition of quality is now enshrined in legislation in The Health and Social Care Act 2012 and forms the basis of the National Quality Boards’ vision of future frameworks for quality. It is defined as: “care that is effective, safe and provides as positive an experience as possible.” These three clear dimensions of quality must all be present in order to provide a high quality service: