Accreditation should move from structure and process to outcome

The separation between purchasers and providers in the NHS has posed a new set of problems in relation to quality assurance. Before 1991 the hierarchical command and control system was relied on to ensure the maintenance of quality standards in NHS hospitals. Hospitals and nursing homes in the independent sector were regulated through registration with health authorities, and the Hospital Advisory Service was responsible for monitoring the long stay sector in the NHS; additional systems for regulating standards were deemed largely unnecessary. Since 1991, however, purchasers have been required to seek new ways of ensuring that the services that they commission are of high quality. And providers, anxious to market their services, have sought ways to demonstrate their quality standards to purchasers.1 2 These twin pressures have increased interest in models of hospital accreditation. …