A FIRST CLASS SERVICE     Quality in the new NHS - Summary

Source: Department of Health website

All patients in the NHS are entitled to high quality care. The Government wants an NHS that is both modern and dependable. A National Health Service that will guarantee fair access and high quality to patients wherever they live.

The achievements of the NHS have been immense. At best, the NHS is the envy of the world. But not all of its services are up to scratch. There are unacceptable variations in performance and practice. These variations in care are wasteful and unfair. And widely differing performance saps the confidence of the public in a National Health Service.

The Government is determined to place quality at the heart of healthcare. For too long the emphasis has merely been on counting numbers, of measuring activity, of logging what could be logged, but this ignored the real needs of patients.

The Government has started a 10 year modernisation programme to ensure fair access to prompt high quality care wherever a patient is treated in the NHS. A partnership between the Government and the clinical professions will put quality at the top of the NHS agenda, where it belongs. That partnership will deliver a first class service for patients.

Setting quality standards

There is no place in the modern NHS for the piecemeal adoption of unproven therapies, or for hanging on to outdated, ineffective, treatments. Better guidance is needed on what works for patients, and what doesn't. Doctors, nurses, midwives and other health professionals, as well as NHS managers and those who commission services, need clear, authoritative, guidance on where new drugs or technologies best fit beside existing treatments.

The Government's intention is to ensure clear, national standards for services, supported by consistent evidence-based guidance to raise quality standards. Matching consistency in quality throughout the NHS with sensitivity to the needs of individual patients and local communities.

The National Institute for Clinical Excellence (NICE)

The Government will set up a new National Institute for Clinical Excellence (NICE) with a broad range of professional expertise, NHS managers, and patient and user representatives. NICE will provide a single focus for clear, consistent guidance for clinicians about which treatments work best for which patients. NICE will assess new and existing interventions for their clinical and cost-effectiveness and produce and disseminate guidance to support frontline staff. Its guidance will also be available to patients, making full use of the new technology available to the NHS.

National Service Frameworks

National Service Frameworks will set out what patients can expect to receive from the NHS in major care areas or disease groups. As 'care blueprints', they will define how services are best provided, to what standards. The Government recently announced work on two National Service Frameworks (NSFs) on coronary heart disease and mental health, building on work already under way on children's intensive care and Calman-Hine cancer services. These Frameworks are a key component of plans to tackle unacceptable variations in quality across the country.

Delivering quality standards

The Government will help ensure national quality standards are applied consistently within local practice through a new system of clinical governance; through extended life-long learning to ensure that NHS staff are equipped to deliver change and are given the opportunity to maintain and develop their skills and expertise, and through modernised professional self- regulation.

Clinical Governance

Clinical governance will be the process by which each part of the NHS quality-assures its clinical decisions. Backed by a new statutory duty of quality, clinical governance will introduce a system of continuous improvement into the NHS.

Life-long learning

Life-long learning will provide NHS staff with the opportunity to continuously update their skills and knowledge to offer the most modern, effective and high quality care to patients. For example, life-long learning will allow NHS staff to identify training needs across professions to aid clinical team-working.

Professional Self-Regulation

Professional self-regulation provides clinicians with the opportunity to help set standards. People need to be confident that the regulatory bodies will exercise rigorous self-regulation over the standards and conduct of health professionals and will act promptly and openly when things go wrong. The Government is committed to working with the professional regulatory bodies to ensure that professional self-regulation keeps pace with public expectations and is more open and accountable. For example, a modernised regulatory system will play a fuller part in the early identification of possible lapses in clinical quality.

Monitoring quality standards

Standards will be monitored through three new mechanisms. A Commission for Health Improvement, a National Framework for Assessing Performance and an annual National Survey of Patient and User Experience. Best practice will be identified and spread. Poor performance will be rooted out.

Commission for Health Improvement

The Commission for Health Improvement will be a new statutory body providing an independent assessment of local action to improve quality. Headed by a new Director of Health Improvement it will be the champion of high quality standards.

The Commission will visit all Trusts in a rolling review programme to ensure that robust clinical governance arrangements are in place locally and that NICE guidance is consistently implemented throughout the NHS. The Commission will also provide a check on the implementation of National Service Frameworks. The Commission will endorse a range of national external clinical audits which for the first time all hospital doctors will be required to participate in.

The Commission will also act as a 'troubleshooter' in tackling serious difficulties. Where there is failure to act to put local problems right or where public confidence in services has been seriously compromised, the Secretary of State for Health can send the Commission into a hospital to take urgent action and report to Ministers on remedial action needed.

National Framework for Assessing Performance

Value for money is important. As a public service, the NHS is accountable to patients and the taxpayer for the proper use of resources. But the emphasis must be on more than counting numbers. It must be about what matters to patients - the overall quality of care provided and listening to the views and needs of those who use and depend on the NHS.

A new National Framework for Assessing Performance will judge how well each part of the NHS is doing to deliver quality services. It will focus on six key areas:

  • Health Improvement
  • Fair Access to Services
  • Effective Delivery of Healthcare
  • Efficiency
  • Patient and Carer Experience
  • Health Outcomes of NHS Care

The performance of each part of the NHS will be measured against these yardsticks. These results will be published to allow hospitals - and the public - to compare performance.

The Performance Framework will be complemented by the publication of progressively more detailed clinical information comparing performance for a range of conditions. As a first step, a range of clinical indicators will be published in October 1998, on a named hospital basis across England. There is a need to ensure that like is compared with like and over time figures will need to be 'risk adjusted' to standardise for factors such as age, severity, casemix and concurrent illnesses. These measures will vary between specialties and procedures. For example, death rates might be a good measure after cardiac surgery but for hip joint replacements, a better measure might be the length of time the new hip lasts.

In future, work on National Service Frameworks (see above) will include the identification of valid quality indicators. These figures will compare like with like, by reflecting the condition of the patient and the complexity of the treatment. For the first time ever, they will be published on a named hospital basis, specialty by specialty, giving patients and their GPs meaningful information on the clinical performance of their local hospital. This is a 10 year rolling programme to improve information on NHS clinical performance.

National Survey of Patient and User Experience

The views and experience of patients are vital indicators of and contributors to service quality. A new National Survey of Patient and User Experience will provide annual feedback on the things that matter most to patients, carers, and service users - from the quality of food to pain relief - to ensure that the NHS hears and acts on the voice of those which it serves. The Survey, for example, could trigger the involvement of the Commission for Health Improvement if services in a particular area are consistently failing to deliver patient satisfaction. For the first time, patients, carers and service users will have a voice right at the heart of the NHS.

Action for quality

The consultation document - A First Class Service: Quality in the new NHS - sets out a formidable agenda for change. An agenda which concentrates on what really matters - improving quality standards, efficiency, openness and accountability. A modern, dependable NHS which will be judged on the quality of its services and how well it responds to the people it serves.

The Government has set out a 10 year modernisation programme which will help the NHS meet the challenges of the next century. A framework for delivering a first class service.

Action to place quality at the heart of the NHS is not about ticking checklists - it is about changing thinking. But the Government alone cannot deliver high standards. A First Class Service sets out the Government's approach and asks for views on how best we can achieve our objectives with the active participation and partnership of those who work in the NHS and those who use NHS services.

A First Class Service: Next steps

Consultation ends on 18 September 1998. A First Class Service: Quality in the new NHS is available from

Published by the NHS Executive
Crown Copyright 1998
This page was created 8 August 1998