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Francis report reveals enhanced quality role for CCGs

Today’s Francis report has called for a ‘rebalance and refocus’ on commissioning to ensure the procurement of enhanced quality standards that drive improvements in the NHS.

It says CCGs must work with the NHS Commissioning Board to devise these new enhanced quality standards. The landmark report also recommends commissioners be entitled to intervene in the management of individual patient complaints if its felt they are not being dealt with satisfactorily and to have ‘powers of intervention’ where substandard or unsafe services are being provided.

It calls for tighter supervision of providers by CCGs and a watertight ‘corporate memory’ to ensure candid information about them is passed on.

And it recommends GPs undertake a monitoring role on behalf of their patients who receive acute hospital and other specialist services

The report by Robert Francis QC says: ‘The commissioning landscape has now changed, with the introduction of the national NHS Commissioning Board, its regional offices and CCGs. However, the essential tenets required of the commissioning process may not have changed. The experience of Stafford shows an urgent need to rebalance and refocus commissioning into an exercise designed to procure fundamental and enhanced standards of service for patients as well as to identify the nature of the service to be provided.’

Failure to comply with such standards should be a matter for performance management by commissioners rather than regulators, according to the report which contains 290 recommendations for making the NHS more patient-focused.

The report adds: ‘The board and local commissioners should develop and oversee a code of practice for managing organisational transitions, to ensure the information conveyed is both candid and comprehensive. This code should cover both transitions between commissioners, for example as new CCGs are formed, and guidance for commissioners on what they should expect to see in any organisational transitions amongst their providers. ‘

Other recommendations for commissioning include :

* the commissioner is entitled to and should, wherever it is possible to do so, apply a fundamental safety and quality standard in respect of each item of service it is commissioning

* the NHS Commissioning Board and local commissioners must be provided with the infrastructure and the support necessary to enable a proper scrutiny of its providers’ services

* the principal focus of commissioners should be on what is reasonably necessary to safeguard patients and to ensure that at least fundamental safety and quality standards are maintained

* commissioners – not providers – should decide what they want to be provided

* commissioners need, wherever possible, to identify and make available alternative sources of provision   

* commissioners should have contingency plans with regard to the protection of patients from harm, where it is found that they are at risk from substandard or unsafe services

The report on the two and a half year inquiry examines the commissioning, supervisory and regulatory organisations which were supposed to be responsible for monitoring Mid Staffordshire NHS Foundation Trust between January 2005 and March 2009, during which there are thought to have been hundreds of patient deaths linked to substandard care.

It builds on Robert Francis QC´s earlier independent inquiry into the care provided by Mid Staffordshire NHS Foundation Trust between January 2005 and March 2009 which lambasted the cost-cutting and target-driven management culture at the hospital which led to appalling levels of care and needless deaths.

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