Clarify oversight responsibilities

92. We accept this recommendation in principle. Patient safety is a critical element of an effective, patient-focused health system and we agree that it is important to be clear about who is responsible for patient safety. The onus on ensuring quality sits primarily with provider Trusts themselves; although commissioners and regulators also have an important role. 93. In "Culture Change in the NHS"21 the Government agreed that it would be sensible to concentrate and consolidate national expertise and capability on safety within a single organisation that can provide strategic leadership across the whole healthcare system. The Government intend to bring under the single leadership of Monitor and the NHS Trust Development Authority the responsibility for leading the patient safety functions that currently sit with NHS England. 94. Through the newly re-established National Quality Board we will continue to improve both the operation of the oversight arrangements in place at present and the understanding of those arrangements by NHS organisations and the public. A network of regional and local Quality Surveillance Groups has been in place since April 2013 to ensure effective intelligence sharing and action on quality concerns between all partners. 95. Where Trusts, for whatever reason, are not able to provide the quality of care required, other parts of the system have a role to play in helping them improve. The Care Quality Commission has been established as the independent inspector of quality and has clear processes in place to identify issues that are brought to light through the inspection process. Where Trusts are unable to rectify identified problems themselves Monitor or the NHS Trust Development Authority provides support to enable the provider Trusts to improve – in UHMB's case through the special measures regime. 96. The Care Quality Commission is inspecting University Hospitals of Morecambe Bay NHS Foundation Trust in July this year to assess its progress against the agreed action plan, and its report will be published in the autumn.

Quality concerns and risks feed into the wider cross-system quality governance framework as set out by the National Quality Board’s framework for System Quality Groups, updated in January 2022.

The National Quality Board (NQB) provides coordinated leadership for quality policy on behalf of national health bodies. The NQB works to promote quality nationally; support local quality improvement with providers, commissioners and those who use services; and identify new challenges and opportunities to improve quality.

The NQB’s framework for System Quality Groups, published in 2022, refreshes existing NQB Guidance on ‘Quality Surveillance Groups’ and provides clarity on System Quality Groups set up as well as the broader ICS quality governance a structure. System Quality Groups are important structures where key health and care partners, such as NHS England and CQC come together to share intelligence and risk on quality of care. Maternity risks and issues should also be raised within this forum for the purpose of intelligence sharing and escalation where appropriate. These forums align with the principles set out in the Perinatal Quality Surveillance Model (PQSM).

Quality concerns and risks feed into the wider cross-system quality governance framework as set out by the NQB's framework for System Quality Groups (SQG), updated in January 2022: https://www.england.nhs.uk/publication/national-guidance-on-system-quality-groups/

The National Quality Board (NQB) provides coordinated leadership for quality on behalf of the Department, Public Health England, NHS England, the Care Quality Commission, NHS Improvement, NHS Digital and the National Institute for Health and Care Excellence.

The NQB works to promote quality nationally; support local quality improvement with providers, commissioners and those who use services; and identify new challenges and opportunities to improve quality.

Quality Surveillance Groups bring together different parts of the health and care system, to share intelligence about risks to quality and identify those risks to quality at as early a stage as possible.

Department of Health response (July 2015):

Accepted in principle.

“through the newly re-established National Quality Board we will continue to improve both the operation of the oversight arrangements in place at present and the understanding of those arrangements by NHS organisations and the public.” (p. 89)

“The Government intend to bring under the single leadership of Monitor and the NHS Trust Development Authority the responsibility for leading the patient safety functions that currently sit with NHS England.” (p. 89)