DH - Landmark day as patients to help put quality at the heart of the NHS and social care - 1 April 09

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Patient feedback on operations and the start of the new NHS and Social care complaints system are two of the measures that will come into force today, marking a major milestone, that will ensure quality of patient care is at the centre of everything the NHS does, the Department of Health announced.

A number of measures, all designed to raise the quality of services and standards in the NHS in England come into effect from 1 April. The measures include:

•  The Performance Framework - will set minimum standards of quality, safety and financial management that patients can expect from the NHS and tackle underperformance in hospitals and primary care trusts. The framework will identify trusts, remove poor managers and bring in new management, including from other hospitals or from the private sector.
• Patient feedback on operations - people who undergo hip or knee replacements, groin hernia and varicose vein surgery will be asked to asses how successful they felt the procedure was and whether they were satisfied with the outcome. The Patient Reported Outcome Measures have been welcomed by clinicians and patient groups as an effective way to provide GPs and their patients with better information about where to go for their NHS treatment.
• The National Quality Board - provides strategic oversight and leadership on quality in the NHS. The Board met for the first time on Monday (30 March).
• " A new, simpler complaints system - which will encourage a culture that seeks and then acts on patient feedback to make services more effective, personal and safe. The new system will also make the NHS more accountable.
• Care Quality Commission starts work - we have brought together the regulation of health and adult social care under one independent regulator. The Commission will have significant new powers to assure people that the services they receive are fair, personal, effective and safe.
• Payment framework for Commissioning for Quality and Innovation - makes a small proportion of income for providers of NHS services dependent on locally agreed goals, to innovate and improve quality of care for patients.

Health Minister Lord Ara Darzi said:

• "Today is a landmark day in the history of the NHS. The systems in operation will help to ensure that the NHS delivers top quality care for patients and most importantly, involve them in decisions about their care.
• "Listening to patients' concerns and their views on the success of their treatment, as well as measuring and rewarding quality across the NHS will help improve services and assist staff and patients to make better informed choices about their care."

1 April also marks the fifth anniversary of the first Foundation Trusts and is the first day that Ambulance Trusts can apply for Foundation Trust status and enjoy these benefits to improve services. In addition, Mental Health Trusts with high secure services become eligible to apply for Foundation Trust equivalent, giving these organisations similar freedoms to Foundation Trusts but maintaining the requirement for central accountability for certain services.

These measures are part of the work to realise Lord Darzi's vision - set out in his Next Stage Review of the NHS, High Quality Care for All published last year - that the quality of patient care should be at the centre of everything the NHS does.

Notes:

1. High Quality Care for All, the NHS Next Stage Review Final Report can be found at: http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/DH_085825

2. The National Quality Board will ensure the overall alignment of the quality system and deliver on specific technical responsibilities including those set out in the Next Stage Review namely to: oversee the work to improve quality indicators, advise the Secretary of State on the priorities for clinical standards set by NICE, and make an annual report to the Secretary of State on the state of quality in England. It will also assume a wider leadership responsibility for driving the quality agenda and acting as a 'powerhouse for change'.

3. A PDF copy of the PROMs guidance and copies of the questionnaires are available from the Department of Health website: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451

4. It is predicted that 250,000 people will be asked to fill out a PROMs questionnaire in 2009/10.

5. The London School of Hygiene and Tropical Medicine conducted a PROMs pilot at 24 sites. Evidence showed excellent participation rates with 80% of patients completing the pre-op questionnaire and 80% of those patients completing the post-op questionnaire. A copy of the final report can be found at: http://www.lshtm.ac.uk/hsru/research/PROMs-Report-12-Dec-07.pdf

6. On April 1 the Department of Health will introduce a single set of arrangements for dealing with NHS and adult social care complaints.

7. Under the new arrangements for the NHS, instead of the current 3 tiers of complaints handling [local NHS provider, the Health Care Commission, then the Health Service Ombudsman] there will be a 2 tier system - with local resolution by the provider and then direct recourse to the Health Service Ombudsman. The new arrangements will also require organisations to learn from complaints and to encourage the public to use the system.

8. The Performance Framework includes the Framework, the Regime for Unsustainable Providers and the Strategic Health Authority Assurance Framework. It will not apply to Foundation Trusts and will only initially apply to acute and ambulance trusts.

9. The Health and Social Care Act 2008 established the Care Quality Commission, which came into being 1 October 2008. The Care Quality Commission will bring together regulation of the quality of health and adult social care services for the very first time. From 1 April 2009, the new Commission will take over the functions of the Healthcare Commission, the Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission (MHAC) to ensure safe and high quality services are provided for people who use health and social care.

10. In respect of healthcare and adult social care provided in England, the new Commission will have responsibilities for:

• registering care providers (including NHS, adult social care and independent sector healthcare providers);
• monitoring compliance with registration requirements;
• using enhanced enforcement powers (if necessary) to ensure service providers meet requirements;
• assess performance of providers and commissioners;
• keeping under review the Mental Health Act;
• a wider range of powers to help it manage the impact of regulation on service providers.

11. The CQUIN framework guidance was published alongside the Operating Framework in December 2008.

12. From 1 April 2009, Ambulance Trusts will be eligible to apply for Foundation Trust (FT) status and Mental Health Trusts with high secure services will be able to apply for Foundation Trust equivalent. An NHS Foundation Trust is an NHS trust that is part of the National Health Service in England that has gained a degree of independence from DH and its SHA. FTs are authorised and regulated by independent regulator Monitor.

13. NHS FTs are not for profit public benefit corporation. They are part of the NHS and the result of the Government's drive to devolve decision making to local organisations and communities. FTs are not directed by Government. They are accountable to their local communities through their members and governors, their commissioners through contracts, Parliament and to Monitor.

14. A Foundation Trust equivalent organisation will be a NHS trust which has been assessed as meeting the same standards as a Foundation Trust. It will be an 'equivalent' organisation rather than a Foundation Trust because the Trust provides high secure services, over which Ministers will retain oversight.

15. For further media enquiries please contact the Department of Health press office on 020 7210 5221.

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