§ Lord Clement-Jonesasked Her Majesty's Government:
What steps they are taking to determine which models of quality systems management in common use would be most appropriate to ensure increased quality assurance in the National Health Service; and [HL601]
What plans they have to evaluate the different approaches to quality management taken within the National Health Service, together with the current proven techniques, to determine which approach would best prevent further failures from occurring within the service. [HL602]
§ Lord Hunt of Kings HeathClinical governance provides National Health Service organisations and health care professionals with a framework for quality improvement which, over time, will develop into a single, coherent local programme for assuring and improving the quality of clinical services.
National Health Service organisations are using a number of different tools to help them implement their own local arrangements to achieve the key components of clinical governance. Some organisations have found the generic quality management schemes (for example ISO 9000, the Excellence Model, Charter Mark and Investors in People) to be useful ways into this process, recognising that these schemes share general management principles with the aims of clinical governance and the Government's overall NHS quality strategy.
The Cabinet Office document Getting it Together—A Guide to Quality Schemes and the Delivery of Public Services, published March 2001, sets out this work in more detail.
13WAThe Commission for Health Improvement's (CHI's) rolling programme of clinical governance reviews of all NHS bodies is under way. These local reviews evaluate the implementation and adequacy of clinical governance arrangements in NHS organisations.
The commission also has the capacity for rapid investigation and intervention to help the NHS identify and tackle serious or persistent clinical problems. In addition, CHI is conducting national reviews to evaluate the implementation of national standards set in national service frameworks (on topics such as mental health) and the take up of the National Institute for Clinical Excellence guidance.
The Commission for Health Improvement has now assessed acute and mental health trusts and health authorities (covering primary care). Further reports have been published, including a review of Bedford Hospital NHS Trust, and these routine review reports will now be published on a regular basis.
We are creating a national patient safety agency in response to the Chief Medical Officer's report An organisation with a memory. This new agency will manage and evaluate the results from the new NHS-wide mandatory reporting scheme for adverse healthcare events to learn and share lessons across the NHS, to help minimise patient risk and improve the quality and safety of care.
The existence of the agency will, we believe, through its work, very significantly reduce the likelihood of major issues like Shipman and Bristol. It will do this in large part through helping promote a reporting culture throughout the NHS that benefits patient safety.
An ongoing research project is evaluating the impact of the NHS Modernisation Agency's clinical governance support programme on participating NHS clinical teams. This project is due to finish at the end of 2002.
§ Lord Clement-Jonesasked Her Majesty's Government:
What plans they have to discuss the basic principles of quality management within the National Health Service, together with the appropriate training of National Health Service staff in these principles, with professional bodies like the Institute of Quality Assurance; and [HL603]
What training in quality management principles is provided to National Health Service management and personnel. [HL605]
§ Lord Hunt of Kings HeathThe NHS Modernisation Agency is a recently launched major initiative within the National Health Service enabling a wide variety of NHS organisations to involve staff and patients in improving services. The agency is using a variety of quality improvement methods and procedures in its work to support NHS organisations on the ground.
The NHS Modernisation Agency combines the work of several pre-existing national teams including the NHS clinical governance support team, national patients access team and primary care development team. The Leadership Centre within the NHS 14WA Modernisation Agency also provides access to quality management principles, tools and techniques for NHS leaders.
Individual NHS organisations also provide opportunities for their own managers to develop necessary quality management skills through continuing professional development and through other forms of management development offered by academic institutions (for example, Master of Business Administration courses) and professional bodies (for example, the Institute of Health Management).
§ Lord Clement-Jonesasked Her Majesty's Government:
What model of quality management system is in use in the National Health Service to establish and evaluate basic performance measures; and [HL604]
What steps they have taken to ensure better quality management within the National Health Service. [HL606]
§ Lord Hunt of Kings HeathQuality is the heart of the Government's agenda for modernising the National Health Service. Quality of care is increasingly being taken into account when judging the performance of NHS organisations.
The basic elements of the NHS quality management system—as set out in A First Class Service—Quality in the new NHS, published in 1998—are all now in place; these are: clear national standards to help raise standards of care and reduce unacceptable variations for specific treatments, conditions and for patient safety, through routes including the National Institute for Clinical Excellence, national service frameworks and a National Cancer Plan; modern organisational delivery mechanisms to implement national standards effectively, dependably and safely—coordinated through comprehensive clinical governance arrangements; and strong monitoring mechanisms—including the Commission for Health Improvement, the NHS Performance Assessment Framework, national and local patient surveys.
This agenda is underpinned by the Health Act 1999, which places a statutory duty of quality on NHS organisations continuously to monitor and improve the quality of the health care that they provide.
The NHS Plan, published July 2000, takes this quality agenda further to cover improving customer service and patient/citizen representation and also sets out plans for a new mandatory reporting scheme for adverse healthcare events, to help minimise risks to patients and improve the quality and safety of patient care.
This is a substantial agenda of reform, requiring major changes to culture and working practices throughout the NHS. However, we have made a good start towards implementing this agenda—increasingly NHS systems and practices are beginning to be refocused on improving quality and people are beginning to get better care as a result.