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National Voices Briefing

This week the government published significant new regulations for all health and social care provision, and we are pleased to say that National Voices has helped to improve these significantly.

There may still be further changes required – particularly with regard to the inclusion of carers and families. These would need to be pursued when the draft regulations go before parliament for approval this autumn.

All registered providers of health and social care will soon have to achieve new ‘fundamental standards’ including the duty of candour, or be fined or prosecuted for breaches.

The standards respond to the Francis Inquiry recommendation that all providers and professionals should be regulated by a small, common set of basic care standards.

We have contributed to a series of consultations on these standards. Our main aim was to ensure that in going ‘back to basics’ the standards would not abandon or sideline significant aspects of person centred care, such as people’s involvement
and control of decisions.

In a separate stream of work on candour, supporting NV member Action against Medical Accidents (AvMA), we pressed for a meaningful duty with the right threshold of harm.

Gains

As we suggested, the draft regulations now include clear wording requiring providers to:

  • enable and support people to be involved in decisions, including treatment decisions [9(3)(c-d and f)]
  • provide opportunities for self management [9(3)(e)], and
  • provide people with the information they need to do these things [9(3)(g)]

The good governance standard [17], which is all about record keeping, at least now makes reference to the use of these data (including patient experience data) for quality improvement.

On all of these the wording could have gone further, but we are pleased that it has improved.

The duty of candour [20] will now be in statute, after a long battle starting in 2011 (and for AvMA and others, well before that).
It states that where a provider becomes aware of a ‘notifiable safety incident’, it must notify and apologise face to face to the person(s) who may have been harmed, explain ‘all the facts’ and what further inquiries are required, and keep a record of this.

Following an earlier panel inquiry we are now happy that the definition of a notifiable incident will cover all cases where someone may have experienced significant harm.

Omissions

Care Planning: We strongly argued for reference to opportunities for people to plan their care. treatment and support together with their providers. There is still no explicit reference to this. From the accompanying document it appears the government considers this is covered by the general wording on involvement in decisions.

Carers and families: The current regulations that will be replaced by these standards carefully reference throughout the involvement of ‘carers, families and representatives’. Despite our recommendation that this should be carried over to the new draft, there is no mention of the role of carers, or of any requirement to involve, consult or respect them. This appears to be a major omission that is out of line with policy and practice elsewhere.

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