The NHS Quality Standards – A better way of achieving quality and efficiency consistently across the NHS?

Quality Standards are described by NICE as disease/condition-specific definitions of high quality health and social care.

The standards operate on four different levels:

  1. To provide healthcare professionals with up to date disease/condition- specific information to guide care decisions;
  2. To let patients know what to expect from their care/treatment;
  3. To provide providers with a benchmark against which they can assess their performance and identify areas for improvement;
  4. To offer commissioners a standard against which they can measure the quality of service being provided.

The aim is to have library of 150 quality standards spanning a broad range of clinical areas.

Four have already been published:

  1. Blood clots
  2. Dementia
  3. Stroke
  4. Specialist neonatal care

Nine further topics, including alcohol dependence, depression, breast cancer and end of life care, are being developed for publication in 2011.

These standards have attracted attention for being clinically driven and not simply imposed by government. Ministers are advised which topics should be commissioned as quality standards by the National Quality Board’s Prioritisation Committee. This committee is resourced by members of the National Quality Board which include Chairs of the CQC, Monitor, NICE and NPSA, the Chief Nursing and Medical Officers, the NHS Medical Director and a number of expert and lay representatives from a wide range of backgrounds including universities, charities and industry.

Once a topic has been commissioned a specifically established NICE multi-disciplinary Topic Expert Group develops the standard, drawing information from a wide range of sources including the Royal Colleges. The standard, in its draft form, is then subjected to 6 weeks of field testing and consultation before the Quality Standards Programme Board performs quality and consistency checks. However, the process by which standards are identified and produced is expected to be reviewed shortly.

Quality Standards are not mandatory for health and social care providers. However, guidance from NICE states that the health and social care system is nonetheless,

“obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality”.

In real terms this means that, although it will not be possible to sue explicitly for breach of a quality standard, non-compliance will be persuasive evidence in any inquest or claim.

Questions have arisen about the relationship between these standards and essential standards of quality and safety set out in the CQC Registration Regulations. NICE state that their standards build on the framework set by the CQC and that the CQC will look to the standards in any review or analysis of care they carry out.

The first quality standards were announced in June 2010, weeks after the decision was made to abolish certain targets set by the previous government. The timing of this led some to speculate that these standards are merely another set of targets, couched in different terms. Indeed, there are certain aspects of the standards that might support this view. For instance, in the standard dealing with stroke, it is provided that every patient with a potential stroke diagnosis should be transferred to a specialist unit within the hour and a confirmed stroke sufferer should be provided with rehab care within 72 hours of discharge. It is arguable that these are similar in nature to the 48-hour GP target.

The official line from the DoH is that these standards are advice as opposed to targets.  Hospitals will not have to report to the government about whether they adhere to the standards.  However, the potential influence of non-compliance on commissioning decisions and therefore on funding may prove to be a great motivator.

The standards have been heralded as a better way of achieving quality and efficiency consistently across the NHS. The BMA’s consultant committee has publically endorsed the standards, praising the fact that they are clinically, not politically driven. However, there are still questions to be answered, such as how will the information on adherence be collected and will it be publically available? In short, the quality standards have made a promising start but there remain issues to be resolved and it will be very interesting to see how they progress in what is undoubtedly a time of change.