Of the 290 recommendations in the Francis Report into the
Mid-Staffs inquiry, many would have an impact on the role of PCTs.
With their abolition now looming, this begs the question of what
CCGs should do in response to the Inquiry Report as they take on
the commissioning mantle.
The starting point is that although there is no legal obligation
on CCGs to even read the report, as Robert Francis QC made clear,
the expectation is that any organisation involved in healthcare
should consider how it should respond to the recommendations made.
The very first recommendation in the report was as follows:
All commissioning, service provision, regulatory and ancillary
organisations in healthcare should consider the findings and
recommendations of this report and decide how to apply them to
their own work
The table below sets out the key areas which may impact on
Recommendations 13 –
introduction of fundamental, enhanced and developmental standards
of healthcare to be imposed as part of the contractual arrangements
between commissioners and providers
Commissioners should be
enabled to promote improvement by requiring compliance with
enhanced standards or development towards higher standards. They
can incentivise such improvements.
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.
In selecting indicators and
means of measuring compliance, 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
Commissioners need, wherever
possible, to identify and make available alternative sources of
Commissioners must have the capacity to monitor
the performance of evey commissioning contract on a continuing
basis during the contract period.
CCGs will be responsible
for ensuring that, if introduced, providers will incorporate and
implement these standards. The standards proposed are those
suggested by the Patient’s Association (see Recommendations 17 &
The extent to which standards are being met by both providers and
commissioners should be monitored by CQC. The Report identified a
need to enable CCGs to be given the infrastructure to monitor
provider services (Recommendation 127-128).
This suggests considerable local discretion for CCGs, but as a step
to be taken now, they may consider examining how far they can
currently impose and enforce quality standards. Performance
management should be a first priority for CCGs under these
recommendations and where concerns are raised they would have to
ensure that all relevant information was obtained. They would be
required to be accountable to the public for the scope and quality
of the services commissioned. In so far as PCTS may currently try
to restrict their obligations to passive monitoring or simple
acceptance of proposals by care co-ordinators or providers, this
would not be permissible.
Recommendations 176 &
statement given to a commissioner by a provider must be truthful
and honest nor mislead by omission. Failure to do so could be a
of all healthcare organisations will be obliged to be truthful in
statements to regulators or commissioners
CCGs will be entitled to expect full and honest
accounts of healthcare provision from providers.
would have a commissioning function, they would also be healthcare
organisations and their directors would be under a similar
Recommendations 120 &
should require access to all complaints information as and when
complaints are made.
Commissioners should be entitled to intervene in
the management of an individual complaint on behalf of the patient
where it appears to them it is not being dealt with
This does not seem to mean that CCGs will have to
be kept informed in parallel as complaints are made, but it could
lead to difficulties in filtering out which complaints need to be
looked into by CCGs, as opposed to all of them. CCGs may have to
commission advocacy and support services for patients bringing
complaints (Recommendation 134)
The aim of these recommendations is to put patient safety at the
heart of all healthcare provision. CCGs, with the support of CSUs,
will have a dual role to administer and ensure compliance. This may
mean small organisations having to take on experienced and
sophisticated providers in negotiations or monitoring, and that may
seem an uneven contest. Be that as it may, it will be a basic
expectation of them to do so successfully.