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Clinical Standards

Volume 171: debated on Tuesday 1 May 1990

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To ask the Secretary of State for Health if he will make a statement on his Department's proposals for future monitoring of clinical standards in the National Health Service and the terms of reference of any monitoring agency.

On 4 April, I invited the presidents of the dental, medical, midwifery and nursing royal colleges for talks on the assessment of clinical standards for National Health Service patients after the proposals in the National Health Service and Community Care Bill are implemented. I put forward ideas for setting up a national multi-professional clinical standards advisory group. That was broadly welcomed by the professions, but further discussions will be needed on the way in which such a group might operate.

I thank my right hon. and learned Friend for that answer. Will he confirm that he and the Department are most enthusiastic about the new proposal and getting the system right? Will he say a little more about the composition of the advisory group? It will be of critical importance in reassuring all opinion—lay and medical—that the standards will e properly monitored.

I am grateful to my hon. Friend because, in broad terms, his reaction is the same as that of the presidents of the medical, nursing and dental colleges. We all agreed that we need more talks about how such a system might work, be financed and so on. On the whole, the composition of any group would need to be determined by the medical, nursing and dental royal colleges, and comprise representatives from all the professions to work on a multi-disciplinary basis.

Is my right hon. and learned Friend aware that perhaps we could learn a lesson from the United States, where peer review organisations examine about one in four operations and determine whether it was necessary in the first place, at what cost it was done and how successful it was? Such detail is more likely to result in patient satisfaction than some overall national body.

I do not envisage a national body taking over the detailed operation of local services. I envisage a national body that will be available as a source of advice if people encounter local difficulties. I agree with my hon. Friend that we require what I call systematic quality control, which is usually described as audit control. We are drawing on American experience, but the royal colleges and the Government would like an even better system introduced in all branches of the National Health Service.

On the monitoring of the health of any community, will not the Secretary of State admit that family practitioner committees are extremely worried about the lack of morbidity statistics in terms of their ability to play a constructive role—if that is not a contradiction in terms—in how the NHS reforms are now being applied?

We have morbidity statistics. I have not had representations from English medical practitioner committees about the inadequacy of the statistics, but I shall certainly make inquiries to see whether the federation believes that it is a problem or whether there is a particular problem in Wales.