Recommendation 240

Hygiene requirements

All staff and visitors need to be reminded to comply with hygiene requirements. Any member of staff, however junior, should be encouraged to remind anyone, however senior, of these.

In its initial response to the inquiry, Patients First and Foremost, the government committed to draw up a new set of fundamental standards of care that will sit within the legal requirements that providers of health and adult social care must meet to be registered with the Care Quality Commission.

In June 2013, the Care Quality Commission issued A new start – Consultation on changes to the way CQC regulates, inspects and monitors care. This document started the public discussion on what the fundamental standards of care should be. The Department of Health has issued draft regulations for consultation, which set these fundamental standards of care in legislation as outcomes that must be avoided, as well as streamlining and improving the clarity of requirements which must be positively achieved in order for a provider to register with the Care Quality Commission. The Care Quality Commission, through its Chief Inspector of Hospitals, is engaging with providers, professionals and the public on what guidance it should publish on complying with these regulations and how they should relate to the Care Quality Commission’s broader assessments of the quality of hospital services. The new regulations setting out fundamental standards of care, and the Care Quality Commission’s associated guidance for providers on them, will come into effect during 2014, subject to Parliamentary approval. The final set of standards is likely to cover areas such as: care and safety of patients and service users; abuse, including neglect; respecting and involving service users, nutrition; consent; governance; cleanliness and safety of premises and equipment; staffing; fitness of directors; and duty of candour.

Local Healthwatch organisations are using their ‘enter and view’ powers to get a clear picture of how health and care services are meeting the needs of the public, and their place on every local health and wellbeing board will ensure that voices of people using services is at the heart of local planning and decision-making. Local Healthwatch will also enhance the new inspection regimes. They will make sure inspection teams get a comprehensive picture of local people’s opinions and concerns, and will maintain a focus on service quality issues after the inspection team has moved on.

In April 2013, a new system of patient-led assessment of the care environment was introduced. This annual inspection is carried out by teams including at least 50% patients or members of the public. It includes an assessment of visible cleanliness and prompts an action plan to address any shortcomings.

Furthermore, the Code of Practice on the Prevention and Control of Infections and Related Guidance sets out the ten criteria against which registered providers will be judged on how it complies with the registration requirement for cleanliness and infection control, although not all criteria will apply to every regulated activity. Currently, registered providers need to demonstrate to the CQC that they have systems in place to manage and monitor the prevention and control of infection, which includes providing and maintaining a clean and appropriate environment.

Part of a trust board’s work to focus its organisation around patient safety will include demonstrating behaviours that instil a culture of openness and learning, where junior members of staff feel able to challenge their senior colleagues, and those in authority react appropriately.


The Care Quality Commission has 11 new fundamental standards will come in to force for all providers in April 2015. These new regulations are clearer statements of the standards below which care should never fail. One of these standards is ‘cleanliness, safety and suitability of premises and equipment’.