A body representing health charities has warned that draft “fundamental standards” being consulted on by the Department of Health could be “a backward step” for person centred care.
Don Redding, policy director at the coalition of health and social care charities National Voices, told HSJ there should be a stronger commitment in the standards to helping people manage their own health and involving them in decisions about their care.
The creation of a list of fundamental standards below which care should never fall was one of Robert Francis’s recommendations in his report into the scandal of poor care at Mid Staffordshire Foundation Trust.
The DH wants the standards to replace the current regulations with which all providers of health and social care registered with the Care Quality Commission must comply.
However, Mr Redding said the notion of person centred care was “inadequately reflected” in the DH’s current wording and called for a redraft.
While person centred care is one of the 11 proposed fundamental standards, Mr Redding said the draft wording is actually weaker than existing regulations, set out in the 2008 Health and Social Care Act (Regulated Activities) regulations.
These say the “registered person must, so far as reasonably practicable, make suitable arrangement to ensure… that service users are enabled to make, or participate in making, decisions relating to their care or treatment”.
The new wording states: “Care and treatment of service users must reflect their needs and preferences… in so far as it is in accordance with generally accepted professional standards, practices and principles for the care and treatment to reflect such needs and preferences.”
Mr Redding said: “Our concern throughout has been that reverting to an emphasis on fundamental standards may risk marginalising issues… to do with person centred care.”
National Voices is not the only organisation to express concerns about the new regulations.
The Foundation Trust Network said it “welcomed” the streamlining of standards but was uneasy about new enforcement powers accompanying the regulations.
The CQC’s enforcement activities will be enhanced by a new power to immediately prosecute providers following the serious breach of a standard. In future there will also be no maximum cap on fines after conviction.
However the FTN’s head of policy Miriam Deakin said this seemed “weighted towards the culture of blame and recrimination” which the Francis review had warned against, and that fining was “likely to make matters worse, not better” for struggling trusts.
Siwan Griffiths, a health solicitor at Capsticks, told HSJ the DH’s proposals would create “much more potential” for prosecution.
Ms Griffiths said: “[The CQC] have the power to bring prosecutions but they can only do it after they’ve issued a warning notice.
“The new proposal is that in relation to some of the fundamental standards the CQC don’t have to issue that notice… so it’s going to make it much easier for CQC to prosecute.”
The FTN also said one of the standards, relating to staffing, could turn National Institute for Health and Clinical Excellence guidelines on staffing levels into “de facto standards”. Ms Deakin said a fear of prosecution could in turn force some trusts to “divert resources” to increase staffing levels, “even though they are capable of providing safe and effective care at existing levels”.
Diane Hallatt, a partner at the law firm DAC Beachcroft, agreed that NICE guidance “could effectively become a standard” but said it was likely the CQC would ensure any guidance was “flexibile enough to accommodate environmental factors, professional skill mix, ward regimes, client groups and dependencies”.
The DH consultation closes on 4 April 2014.