172.The White Papers The new NHS and Putting Patients First announced the intention to place a new duty of quality on NHS trusts. At present there is no statutory duty on NHS trusts in respect of the quality of care they provide to patients (although they owe a duty at common law to exercise reasonable care and skill in providing medical treatment and other services).
173.Under this section Health Authorities, NHS trusts and Primary Care Trusts will be required to put and keep in place arrangements for monitoring and improving the quality of the health care they provide. A fundamental component of those arrangements will be the implementation of clinical governance arrangements. The concept of “clinical governance” was discussed in the consultation documents A First Class Service and Quality Care and Clinical Excellence, which set out in more detail the Government’s plans to improve the quality of NHS healthcare. The main components of clinical governance as described in the consultation documents are:
	clear lines of responsibility and accountability for the overall quality of clinical care;
	a comprehensive programme of quality improvement systems (including clinical audit, supporting and applying evidence-based practice, implementing clinical standards and guidelines, workforce planning and development);
	clear policies aimed at managing risk; and procedures for all professional groups to identify and remedy poor performance.
It is intended that the detail of what is expected of Health Authorities, NHS trusts and Primary Care Trusts in implementing clinical governance will be set out in guidance. The first tranches of clinical governance guidance were published in March 1999 (under HSC 1999/065 in England and WHC (99)54 in Wales).
174.Subsection (3) enables the Secretary of State to extend the duty of quality to Special Health Authorities. The intention is to use this power in respect of the three Special Health Authorities that provide high security psychiatric services (Ashworth, Rampton and Broadmoor).
Commentary on Sections Part I - the National Health Service Section 18: Duty of Quality