Report on Quality in the New Health System

Topics covered: Ridouts professional advice

The National Quality Board (NQB) has published a report which sets out how quality will be preserved and improved in the new health system.

The NQB combines the national organisations across the health system accountable for quality including the Care Quality Commission, Monitor, the NHS Trust Development Authority, NICE, the General Medical Council, the Nursing and Midwifery Council, the NHS Commissioning Board Authority and the Department of Health.

The draft report focuses primarily on how the new system should prevent, detect and respond to serious failures in quality and offers a statement from NQB members as to:

  • the nature and place of quality in the new health system
  • the distinct roles and responsibilities for quality of the different parts of the system
  • how the different parts of the system should work together to share information and intelligence on quality and to ensure an aligned and coordinated system wide response in the event of a quality failure
  • the values and behaviours that all parts of the system will need to display in order to put the interests of patients and the public first and ahead of organisational interests.

Summary of the Report

Over the next few years, the structures in the NHS will change as a result of the Health and Social Care Act 2012 and in response to the NHS rising to the challenge of delivering better quality care in a stricter financial environment.

By April 2013

  • Health and Wellbeing Boards will be established.
  • Monitor will have become the new sector regulator for all NHS funded care.
  • All NHS Trusts will be on their way to becoming Foundation Trusts free from central direction or control.
  • The NHS Trust Development Authority will be established to oversee the performance of NHS trusts.
  • Health Education England will be established.
  • HealthWatch will become the new champion for the patient voice.
  • A number of arms length bodies will have been abolished.

This definition of quality has now been enshrined in legislation through the Health and Social Care Act 2012 and incorporates clinical effectiveness, safety and patient experience.


From 1 April 2013, all primary medical care providers, including GP practices will be registered with the CQC.

Increasingly CQC will also identify and highlight what works well in the services it inspects. This will facilitate the sharing of useful intelligence about what works well and motivate providers to continuously improve. It will draw on its unique sources of evidence and intelligence to become a more authoritative voice on the state of care.

CQC will fulfil its objectives by:

Working closely with strategic partners to effectively pool and share information and intelligence that all can draw upon and use;

  • understanding the patterns of good (what works well) and poor care;
  • reporting on the state of the market, identifying problems and challenges in how services are provided and commissioned and recommending action;
  • using ‘special review’ powers, themed inspection programmes and thematic reviews to deal with specific areas of concern that require improvement;
  • working with regulators and commissioners to determine how best to regulate and influence the sector and providers;
  • influencing the Department of Health on how the sector is regulated and any changes needed in the law to support regulation, including the ongoing review of the legislative framework;
  • publishing information on inspections and reports; and
  • listening to people and putting them at the centre of our work.

CQC is a vital member of the new local and regional Quality Surveillance Group, where they will share information and intelligence about providers with other parts of the system, and use information and intelligence from others to inform their judgements on quality.


Healthwatch will be a statutory committee of CQC, established to enable people to help shape and improve health and social care services. It will operate at both a local and national level, championing the views and experiences of patients, their families, carers and the public.

Healthwatch locally will be a valuable source of information and intelligence which they should share as members of Quality Surveillance Groups. If they have concerns about any of the providers in their area, QSGs are one of the routes through which they can be raised and shared.


During 2013, Monitor will become the sector regulator for healthcare. Amongst other functions, Monitor will jointly licence providers of NHS funded care with CQC.

Where CQC judge that a provider is delivering poor care, and where Monitor determines that the poor care resulted from poor governance, Monitor could impose additional conditions to rectify the failings of governance.

Monitor will have a close working relationship with CQC in particular, working with them on judgements on quality. It should have regular bilateral discussions with CQC at every level, sharing information and intelligence routinely, and discussing any steps it intends to take as a result of quality concerns to ensure coordinated action.

Health and care professionals

All staff, working in hospitals, care homes, general practice or in providing community care have a role in ensuring safe care for patients and service users through their own ethos, values and actions. They are the first line of defence against quality failure.

Health and care professionals should regularly participate in clinical and quality governance and measure indicators on the quality of care they are providing, identifying areas for improvement and reporting within their organisation. At a minimum, they must ensure that the services they provide meet the CQC’s ‘essential standards of quality and safety’.

Where health and care professionals have concerns about the quality of care, they should raise these with the leaders in their team, or the clinical leaders in their organisation. If they feel they cannot raise concerns individuals should follow their organisation’s published whistleblowing procedures.

Clinical Leaders

Clinical leaders within provider organisations will include anyone who has a leadership role in respect of health and care professionals, such as the Medical and Nursing Directors, the consultant body, clinical managers, the matrons/sisters at ward level or team leaders in care homes.

Clinical leaders have responsibility for ensuring effective clinical and quality governance and that the culture in the organisation supports the right values and behaviours amongst their staff, to provide quality care and feel comfortable to raise any concerns.

Clinical leaders are also responsible for supporting staff to fulfil any professional obligations and for investigating concerns about the behaviour or clinical practice of the professionals they oversee in the first instance. They must ensure that referrals are made to the relevant professional regulatory body where necessary.

Provider leadership

The leadership of a provider organisation (including the executive and non‐executives in leadership roles) is ultimately responsible for the quality of care being provided across their organisation.

The provider leadership must ensure that their organisation is registered to provide the services they are providing with the Care Quality Commission, and that the organisation continues to meet the ‘essential standards of quality and safety’, including statutory notifications. For licence holders, the leadership should ensure that the organisation continues to be compliant with the conditions of its licence, as determined by Monitor.

Local authority commissioners

Local Authorities are responsible for commissioning social care services and managing the contracts they hold with providers of care services. Through these contracts, they can set requirements for providers in relation to the quality of care delivered.

Local Authorities will be part of the new local Quality Surveillance Groups, where they should share information and intelligence. If they have concerns about whether providers are meeting the ‘essential standards of quality and safety’ they should raise these with the CQC and with any other parts of the system with an interest through that Group.


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