L Cowling

[FOI #18167 email]

By Email

Our Ref: CQC IG 120

12 October 2009

Dear Sir or Madam,

Re: Information Request

I write in relation to your two emails of 17 September 2009 where you requested the following information under the Freedom of Information Act 2000:

1. Further to your response to Mr Oakley, in that "Neither the Healthcare Commission nor the Care Quality Commission requires trusts to declare compliance with individual NICE guidelines"

Does this mean that they can only declare compliance if they have implemented ALL relevant NICE guidelines? If they have not, then surely action should be taken by the CQC with regards to the following Department of Health Statement?

"When NICE recommends a treatment, NHS organisations must provide funding for it. They have a maximum of three months from the date of publication of NICE final guidance to provide funding and resources. Local NHS organisations are expected to meet the costs of medicines and treatments recommended by NICE out of their general annual budgets.

Where there is evidence that NHS Trusts are restricting access to NICE recommended treatments solely on cost grounds, the Department looks to Strategic Health Authorities (SHAs) to intervene. Trusts could ultimately be exposed to legal proceedings if they have failed to meet their statutory obligations"

2. Could you provide me with a copy of the guidelines/assistance given to Trusts by the CQC in order for them to fill in the core standards declaration?

The Commission responds as follows:

1. Core standard C5a (Standards for Better Health) requires organisations to ensure that they conform to National Institute for Clinical Excellence (NICE) technology appraisals (TA) and, where it is available, take into account nationally agreed guidance when planning and delivering treatment and care.

The Commission asks NHS trusts to make an annual declaration that they do as the standard states. We expect them to declare that they conform to each NICE TA and take account of each NICE guideline that applies to the services they deliver. We do not ask them to name every TA and every guideline that is applicable to them in their declaration.

If the Commission found that a trust had declared that they were meeting the standard but had evidence to suggest that a trust was not conforming to any TAs that were applicable to the services it delivered then the Commission could visit the trust to ask further questions. This could result in the trust being deemed not to have met the standard and would affect the outcome of their annual rating.

Nice guidelines are a little different as trusts need only take them into account, they are not mandatory. However, we would look to see if a trust had taken into account applicable NICE guidelines, and if it had chosen not to implement them, that it had clearly articulated its reasons for not doing so (this may be because it had decided to use other evidence based guidelines such as those produced by Royal Colleges, which is perfectly acceptable). If a trust declared that it was taking into account applicable guidance and the Commission had evidence to the contrary, the Commission could visit the trust to ask further questions. Again the outcome would affect the trusts annual rating.

Fundamentally though, responsibility lies with the trust to assure itself that they are conforming to NICE TAs and take account of NICE guidelines.

The Commission will implement a new regulatory framework from 1st April 2010. It has recently completed consultation on its guidance document which sets out how providers of health and adult social care services demonstrate their compliance with regulations made under Section 20 of the Health and Social care Act 2008 and, specifically, the Health and Social care Act 2008 (Registration Requirements) Regulations 2009. The regulations have been produced by the Department of Health and have been subject to public consultation.

In respect of the new framework, where an organisation fails to comply with the registration requirements, the Commission would be able to take appropriate action; from placing conditions on the registration through to suspending services. Therefore, whilst the status of NICE guidelines remain unchanged, if an organisation is deemed not to be delivering safe and effective care (in accordance with the regulations) and one of the reasons for this is because the trust is not conforming to NICE TAs or implementing NICE guidelines, the Commission would be able to take appropriate action (proportionate to the risk to people who use services).

http://www.cqc.org.uk/guidanceforprofessionals/healthcare/nhsstaff/annualhealthcheck2008/09/qualityofservices/corestandards.cfm

http://www.cqc.org.uk/guidanceforprofessionals/healthcare/nhsstaff/annualhealthcheck2008/09/qualityofservices/core/corestandardsinspectionguides2008/09.cfm

I hope you find the information useful.

You may complain about any aspect of your FOIA request. In the first instance, please address your complaint to:

Information Governance Team

Care Quality Commission

Finsbury Tower

103-105 Bunhill Row

London

EC1Y 8TG

Or: [Care Quality Commission request email]

Further rights of appeal exist to the Information Commissioner's Office once the internal complaints process has been exhausted.

Yours sincerely

Kim Lok

Information Governance Manager

Information Governance Team

Care Quality Commission

Finsbury Tower

103-105 Bunhill Row

London

EC1Y 8TG

www.cqc.org.uk

Chairman
Barbara Young

Chief Executive
Cynthia Bower

Registered office:
Finsbury Tower
103-105 Bunhill Row
London EC1Y 8TG