Fundamental standards: improving quality and transparency in care

The government has announced legislation which introduces fundamental standards for health and social care providers. Subject to parliamentary approval, they will become law in April 2015.

The new measures are being introduced as part of the government’s response to the Francis Inquiry’s recommendations and are intended to help improve the quality of care and transparency of providers by insuring that those responsible for poor care can be held to account.

How the fundamental standards will work in practice:

  • the fundamental standards will define the basic standards of safety and quality that should always be met, and introduce criminal penalties for failing to meet some of them.
  • the standards will be used as part of the Care Quality Commission’s (CQC’s) regulation and inspection of care providers. The CQC will be able to hold providers to account if they are not being met, including through the courts where appropriate. Registration with the CQC will also be dependent on compliance.
  • the duty of candour will require NHS bodies to be open and transparent with service users about their care and treatment, including when it goes wrong.
  • the fit and proper persons requirement means that all directors of NHS bodies must pass a test proving they are fit and proper persons. The CQC will be able to insist on the removal of directors that fail.

These measures were recommended by the Francis Inquiry report and thousands of people responded to a series of consultations about their introduction. Most of those who responded to the consultations were in favour of the measures and the responses were used to improve the development of the regulations.

The government’s response to these consultations explains the changes it has made as a result of the feedback received in full.

As part of the fundamental standards, a new duty of candour and fit and proper persons requirement for directors will be introduced for NHS providers from October 2014, and will be extended to all providers by April 2015, subject to parliamentary approval.

The fundamental standards are:

  • care and treatment must be appropriate and reflect service users’ needs and preferences
  • service users must be treated with dignity and respect
  • care and treatment must only be provided with consent
  • care and treatment must be provided in a safe way
  • service users must be protected from abuse
  • service users’ nutritional and hydration needs must be met
  • all premises and equipment used must be clean, secure, suitable and used properly
  • complaints must be appropriately investigated and appropriate action taken in response
  • sufficient numbers of suitably qualified, competent, skilled and experienced staff must be deployed
  • persons employed must be of good character, have the necessary qualifications, skills and experience, and be able to perform the work for which they are employed
  • registered persons must be open and transparent with service users about their care and treatment (the duty of candour)
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