Policy responses and statements

Name of organisation:

Monitor (Independent Regulator of NHS Foundation Trusts)

Name of policy document:

Developing the Compliance Framework: Clinical Quality and Service Performance

Deadline for response:

30 June 2006

Background: This document details how Monitor proposes to develop the Compliance Framework. The proposals underline the full responsibility of foundation trust boards for all aspects of the operations of their trust including clinical quality and service performance. Monitor outlines how it will ensure that boards undertake this responsibility and how it might intervene if they do not.

The document also sets out how Monitor proposes to assess the governance risks faced by an NHS foundation trust in relation to the delivery of national targets and core standards.

COMMENTS ON
Response form for consultation, Developing the Compliance Framework: Clinical Quality and Service Performance

Full name:                              Dr John S A Collins MD FRCP Edin

Job title:                                 Secretary

Organisation:                        Royal College of Physicians of Edinburgh

Nature of organisation:       Medical Royal College

Contact address:                  9 Queen Street, Edinburgh EH2 1JQ.

Telephone number:             0131-225 7324

Email:                                     l.lockhart@rcpe.ac.uk

Please write your answers to the following questions below. Please continue on further sheets if necessary. Then follow the instructions at the end of this form to return your response to Monitor.

General comments:

The report describes  the process of identifying the type of situation that could lead to Trusts failing, but does not at any stage clarify how it would seek advice on current clinical practice from professional bodies, such as the Royal Colleges or how it would refer for the latter’s opinion, if such a situation were to arise.  In addition, it does not say how it would identify the most relevant national/local responsible authority.

There is also no reference to the obligation of Foundation trusts to contribute to the workforce development needs of the NHS as a whole through training and education. This is inextricably linked with clinical quality and should be explicit within the governance framework.

The report describes how Boards should discharge their responsibilities, but is not specific on how it will identify Trusts that are failing.  It describes an annual plan with in-year monitoring, but needs assurance that the clinical standards not included within core standards or national targets are also met.  Royal Colleges can support in this area.

Clinical quality is discussed as one of the seven elements of clinical governance, but is number six on the list and behind service performance.  This should be reversed, as the latter is meaningless without first securing the former (paragraph 2.4) and would send a positive signal about the importance of clinical quality and safety.

The College welcomes the recognition of the importance of highlighting Trusts in potential trouble before they are categorised as problematic, particularly at this time of financial stress.

Answers to specific questions:

1. Do you agree with Monitor’s definition of NHS foundation trust board responsibility?  If not, please describe how it should be modified.
   
   Generally the definition is acceptable, but the College remains concerned about the absence of references to training and education responsibilities and the consequent importance of appropriate clinical supervision and assessment of trainees.

2. Do you agree that the proposed self-certification is the correct way for Monitor to ensure that boards discharge their duties with respect to clinical quality? 
   
   Yes, as long as clear guidelines are available for Trust boards to seek advice on the criteria for self-certification and on what clinical standards are to be followed.  They should not seek minimum standards of care.  Equally important would be early review of the system to assure the public that exception reports and self- certification are accurate.

3. Do the proposed reporting mechanisms add unnecessarily to the regulatory burden? If so, please explain why and suggest what alternative means that can best ensure that boards are appropriately discharging their responsibilities with respect to clinical quality.
   
   If local quality systems are effective, the resulting data should serve all purposes in terms of reporting responsibilities to the local public, the Health Commission and other interested quality assurance bodies, including Royal Colleges.  However, Monitor will have a key role in ensuring timely follow-up action in the event of exception reports.

4. Do you agree with the proposed method for evaluating governance risk?  Is the process clear and easily understood?
   
   Generally, the method is easily understood, although the 3 categories are rather broad and fail to discriminate within the categories.

5. Does this document adequately describe how Monitor and the Healthcare Commission will work together?  If not, please describe what is unclear and any recommendations you may have.
   
   The report does not make adequately clear who will trigger the investigation, Monitor or the Healthcare Commission.  Monitor will pick up an inadequacy, but to whom will it refer for professional advice before the Healthcare Commission acts?  It would be helpful for the independent and informed expertise of the Royal Colleges to be listed explicitly within the broad references to “another recognised third party” or “professional bodies”.  This will offer reassurance to the public that such expertise is recognised as an important component of governance within foundation trusts.

6. Do you agree with Monitor’s proposed approach to handling quality and service information it may receive from third parties?  If not, what suggestions would you make?
   
   Yes, in principle, but clinical quality needs to be at the top of the list of variables and the role of Royal Colleges in the independent assessment of potential or actual problems should be strengthened.

7. Are the actions to be taken in the event of a concern over clinical quality or service performance clear?
   
   See 5 and 6 above.

8. Do you have any comments on the ways in which Monitor may work with third party organisations?  Are there any further issues you would like to see addressed?
   
   See previous responses.

Thank you for responding to this consultation. Please save this document, and email it to consultation@monitor-nhsft.gov.uk.

Alternatively, you can fax your response to 020 7340 2401, or post it to Monitor, 4 Matthew Parker Street, London, SW1H 9NL

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324    ext 608
Fax: 0131 220 3939

[30 June 2006]