Hospital managers will face legal action if clinical care fails to meet acceptable standards, health minister Alan Milburn announced this week.

He revealed that a new 'legal duty of quality' would be placed on trusts for the first time next year, in a drive to improve care following a recent run of scandals.

And he insisted that the principles of good 'clinical governance' will apply in primary and community care 'just as much' as in the acute sector.

Mr Milburn this week put more detail on government plans to introduce 'clinical governance', which were signalled in last year's white paper, The New NHS .

'Until now, the principal legal duties of trusts have been financial, ' he said.

'Balancing the books remains important, but quality of care to patients should be the first priority.'

The move follows notable incidents, including deaths linked to cancer screening failures.

The new arrangements would 'ensure that every hospital focuses on safeguarding and improving quality of care', Mr Milburn said.

A new statutory duty of quality will be put in place, subject to legislation, in 1999. It will be complemented by a 'new framework of clinical governance' which will be designed to ensure that all NHS organisations have 'proper processes for continuously monitoring and improving clinical quality'.

All hospitals will have to appoint 'a doctor, nurse or other clinical professional to take charge of quality issues' and monitor their effectiveness.

NHS boards will have to establish ways of discharging their responsibilities for clinical quality, probably through setting up a sub-committee.

Regular reports on quality will have to be submitted to boards and will be seen as 'equally important' as monthly financial reports. There will also be annual reports on clinical governance.

Chief executives will be held ultimately accountable for progress locally.

A briefing paper for ministers, seen by the Journal , states: 'Staff should be as familiar with clinical governance arrangements as they are with standing financial orders.'

Quality standards will need to be evidence-based and clinical audit systems in all clinical departments will ensure that good practice, ideas and innovations can be evaluated, says the government.

Procedures for all professional groups will ensure poor performance can be identified and remedied and 'build on the best of self-regulation'. There will be no separate NHS code of conduct.

Quality standards will be overseen by the new Commission for Health Improvement, which will 'intervene' when necessary to help sort out problems, and the National Institute for Clinical Excellence.'

The new system is designed to give 'a level of assurance' to patients that their faith in health professionals is well placed.

'Each individual should know the part they have to play in ensuring quality, ' it adds.

'As primary care groups move towards becoming trusts, they will be expected to have incorporated clinical governance in action.'

A consultation document will be published later in the spring, seeking views on how to put the system in place.

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