‘New’ fundamental standards for care – where should the Department of Health
and the Care Quality Commission start?
The long awaited Francis Inquiry reported back in February and now is the time to
move on and look ahead and put some of his recommendations into action in
England. An area that probably resonates with us all; as patients now or in the
future, and as professionals, is refreshing the fundamental standards. The underlying
idea is not new but perhaps the crux of the issue is that the way that they are
expressed and assessed has become too disperse and too complex.
Francis tells us that the fundamental standards should be “easily understood and
accepted by patients, the public and healthcare staff, the breach of which should not
be tolerated”. The Department of Health (DH) has the job of looking again at
legislation to bring in the new fundamental standards, and the Care Quality
Commission (CQC) the job of designing and implementing a regulatory system
which will support compliance with them, and that also means deciding how they will
be measured. Given a zero tolerance approach the fundamental standards could use
a different approach to that taken to date; to specify what is ‘unacceptable’ and
therefore signalling clearly where the bar below which no organisation and individual
can fall is set. The DH and the CQC’s jobs will not be easy and will require close
working with all healthcare professionals if we are to deliver the fundamental
standards every day, and in every care setting.
Francis also says “The standards to be enforced by the regulator should be a clear
fundamental set of standards, driven by the interests of patients, and devised by clinicians; a
“bottom up” as opposed to a“top down” system.
There is an understandable haste to move ahead and forge these new fundamental
standards and how to measure if they are being complied with, but much can be
learned from work on this before; the essence of care offer some insights as do the
RCN’s Principles of Nursing Practice developed with patients to set out the
fundamentals for nursing care. No doubt there will be other work that is relevant
across the UK and further afield.
Will that be enough? The new fundamental standards need to be reality checked
and be delivered on the complex and demanding frontline of patient care. Just what
is unacceptable in that reality needs to be spelt out to all. Nurses everywhere have
the chance to put forward standards that they already uphold, they want to uphold,
and that they can deliver day in day out.
Please be aware of the forthcoming consultations from both the Department of
Health and CQC and get in contact with leela.barham@rcn.org.uk to share your
views.
Leela Barham, RCN Policy Advisor
England