England - National standards and key strategies
See also key agencies.
Most of the documents below are in PDF format - see how to access PDF files
Care Quality Commission (CQC)
The Care Quality Commission (CQC) is the independent health and social care regulator for England. The CQC regulates health and adult social care services provided by the NHS, local authorities, private companies and voluntary organisations. The CQC also protects the rights of people detained under the Mental Health Act.
See also:Raising standards, putting people first. Our strategy for 2013 to 2016. This describes the changes that the CQC is making to the way they inspect and regulate health and social care services These changes will come into effect in NHS hospitals and mental health trusts first.
All providers of health and social care are required by law to be registered with the CQC and to demonstrate compliance with the outcomes described in the Essential standards of quality and safety. The 16 standards that relate most directly to the quality and safety of care are listed at The essential standards.
Guidance for providers of health and social care on compliance with these standards is at Guidance about compliance.
Putting quality into the Care Quality Commission in England (2012) (PDF 605KB)
Results of a new RCN survey show that members believe the Care Quality Commission (CQC) needs to improve to become truly effective. The RCN has published 10 recommendations for change, to improve the relevance and credibility of the health care regulator for England. More work needs to be done in assessments around issues such as staffing levels and skill mix.
NHS Constitution for England
The NHS Constitution was originally developed as part of the NHS Next Stage Review led by Lord Darzi, and first published in 2009. The Constitution establishes the principles and values of the NHS in England. It sets out rights to which patients, public and staff are entitled, and pledges which the NHS is committed to achieve, together with responsibilities, which the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively. This is the 2013 update which reflects an initial response to the report into the failings at Mid Staffordshire NHS Foundation Trust by Robert Francis QC. There is also an accompanying handbook to the Constitution.
National Service Frameworks (NSFs)
National service frameworks (NSFs) are long term strategies for improving specific areas of care. They set national standards and measurable goals within set time frames. This section of the NHS Choices website provides comment on of the role of NSFs. The links below take you to the relevant section of the Department of Health's website for each NSF.
There are NSFs for the following conditions and population areas:
- cancer - Cancer Reform Strategy which builds on the progress made since the publication in 2000 of the National Cancer Plan.
- children and maternity
- Chronic Obstructive Pulmonary Disease (COPD). An outcomes strategy was published in 2011 - see An outcomes strategy for people with chronic obstructive pulmonary disease and asthma in England
- coronary heart disease
- long term conditions - see also information on policy that is brought together on the Department of Health website at Long term conditions
- mental health
- older people
- kidney disease. The framework is in two parts - Part 1: Dialysis and transplantation; Part 2: Chronic kidney disease, acute renal failure and end of life care.
Essence of Care 2010
Essence of Care has been updated and now contains 12 benchmarks, following a consultation exercise late in 2009. It provides a structured and patient-centred approach to identifying best practice and setting standards for these fundamental aspects of care, and highlights the importance of seeking patient and carer opinion. It acts as a tool for sharing and comparing practice, for developing action plans for improvement and audit, and for identifying education and training needs. The 12 areas, each of which has its own benchmarks, are: bladder, bowel and continence care; the care environment; communication; food and drink; personal hygiene; prevention and management of pain; prevention and management of pressure ulcers; health and wellbeing; record-keeping; respect and dignity; safety and self care. The Essence of Care (EoC), was first launched in 2001 and emerging from the 1999 nursing strategy 'Making a difference', formed the basis of a government strategy for improving the quality of care and became an integral element of the clinical governance agenda. This edition supersedes the previous versions originating since 2001.
You can also find related policy and reports within each of the six themes. View the five themes on the homepage.
Compassion in practice. Nursing, midwifery and care staff: our vision and strategy (2012) (PDF 850.5KB)
Published by the Department of Health in December 2012, following on from a consultation, this three-year vision and strategy aims to build the culture of compassionate care in all nursing, midwifery and care-giving settings throughout the NHS and social care. The vision is based around six values – care, compassion, courage, communication, competence and commitment, known as the Six C's. It sets out six action areas for delivering the vision: Helping people to stay independent, maximise well-being and improving health outcomes; Working with people to provide a positive experience of care; Delivering high quality care and measuring the impact; Building and strengthening leadership; Ensuring we have the right staff, with the right skills, in the right place; Supporting positive staff experience. Examples of what each area encompasses and actions that support it are provided.
Nursing Care Quality Forum
This new forum was announced by the Government in January 2012. It was set up with the aim of improving the quality of nursing care across all care settings. It will begin its work by identifying and supporting the spread and adoption of best practice across four areas: how to promote and achieve accountable and empowered nurse leadership across the system; how to make sure that the right culture and the right values that put patients first prevails at all times; how best to involve, listen to, hear and respond to feedback from patients and how to make sure that those providing care have the time to do so properly. See: Nursing and Care Quality Forum mission statement (PDF 18.7KB).
The first Mandate between the Government and the NHS Commissioning Board, published in November 2012, sets out the ambitions for the health service for the next two year. It is structured around five key areas which are equivalent to the five domains which provide the structure for the NHS Outcomes Framework (see below).
NHS Outcomes Framework 2012-13
The framework is structured around five domains, which set out the high-level national outcomes that the NHS should be aiming to improve on. These domains focus on: preventing people from dying prematurely; enhancing quality of life for people with long-term conditions; helping people to recover from episodes of ill health or following injury; ensuring that people have a positive experience of care; treating and caring for people in a safe environment, and protecting them from avoidable harm.
The outcomes and corresponding indicators will be used to hold the NHS Commissioning Board to account for the outcomes it delivers through commissioning health services. One of the aims of the framework is also "to act as a catalyst for driving quality improvement and outcome measurement throughout the NHS by encouraging a change in culture and behaviour, including a stronger focus on tackling health inequalities" (p.4).
There will also be an Adult social care outcomes framework and a Public health outcomes framework.
Health and Social Care Act 2012
The Health and Social Care Bill gained Royal Assent on 27 March 2012 to become the Health and Social Care Act (2012). The Bill took forward the areas of Equity and Excellence: Liberating the NHS and the subsequent Government response Liberating the NHS: legislative framework and next steps. It includes provisions and proposals for public health services and reform of the Department of Health's arm’s length bodies. For details of the later stages of the Bill on the Department of Health's website see Health and Social Care Bill.
The following list of resources provide further information on the changes brought about by the Health and Social Care Act 2012.
- RCN: Health and Social Care Act 2012. This page brings together a number of briefings and resources on the act, which go some way to explain the changes brought about by the act and what RCN members working in the NHS might expect to see happening in their workplace and locality.
- RCN: Navigating the new NHS in England. This page provides information and resources on the developments following the publication of the NHS White Paper Equity and excellence: liberating the NHS such as the developments in clinical commissioning, workforce issues, the Public Health White Paper.
- RCN: Clinical commissioning. This page provides information on the new public bodies which will commission clinical care in England, and on the role of nurses in the new system.
- King's Fund (2012) Never again? The story of the Health and Social Care Act 2012.
- King's Fund (2012) Reading list on the NHS reforms.
- Nuffield Trust (2012) The new structure of the NHS in England. Slideshow showing the main changes to management, accountability and funding structures resulting from the Health and Social Care Act.
- DH: The health and care system in 2013. A diagram providing a developing overview of the health and care system from April 2013.
NHS Future Forum second set of reports (2012)
These reports set out a series of recommendations to improve the quality of patient care and achieve better outcomes. There are summary reports on integration, education and training, information, and the NHS’s role in the public’s health. The Government has accepted the recommendations made - see Government accepts new recommendations from NHS Future Forum.
Equality and excellence: Liberating the NHS (2010)
This White Paper sets out the Coalition Government’s long-term vision for the future of the NHS and signals a major restructuring of the NHS. Key features of the plans include: putting patients at the centre and strengthening the public and patient voice; a focus on quality standards and outcomes reducing the emphasis on process targets; giving practitioners greater autonomy in particular devolving responsibility for commissioning services to local consortia of GP practices; and a reduction of bureaucratic and administrative costs. A new Public Health Service will integrate and streamline existing health improvement and protection bodies. The period of consultation closed on 11 October 2010.
For further information on the work the RCN has been doing around the White Paper on behalf of RCN members, and for information and resources on the developments following on from the White Paper, such as clinical commissioning, workforce issues and the Public Health White Paper see RCN: Navigating the new NHS in England.
National Quality Board
The NHS Review report 'High quality care for all' recommended the formation of a National Quality Board "to provide strategic oversight and leadership". The board has been established as a multi-stakeholder board which will champion quality and ensure alignment in quality throughout the NHS. Specific responsibilities set by the NHS Review report are to oversee the work to improve quality metrics and to advise the government on priorities for clinical standards. This section of the Department of Health's website provides further information on the role, membership and activities of the Board.
Quality Accounts: Quality accounts toolkit 2010/11
In 'High quality care for all' the Government proposed that all providers of NHS care should produce annual quality accounts to give the public information on the quality of care they provide. This toolkit was aimed at providers of NHS services, in order to offer advice as they set out to produce their Quality Accounts for June 2011.
Transforming Community Services
The Transforming Community Services programme launched in 2009 arose from the vision set out in 'NHS Next Stage Review: Our vision for primary and community care'. The programme aimed "to improve community services so that they can provide modern personalised and responsive care of a consistently high standard". This section of the Department of Health website details the policies, projects and initiatives that were in place to support this aim.
NHS Next Stage Review
The NHS Next Stage Review final report is the culmination of a process which started in July 2007 when Lord Darzi was asked to conduct a wide-ranging review of the NHS. The report presents a vision for quality services through a number of themes.
This section provides links to the final report and related reports which are available on the Department of Health website:
- High quality care for all: NHS Next Stage Review final report (2008)
- NHS Next Stage Review: Our vision for primary and community care (2008)
- For the related reports on workforce implications see Staff focus: policy and reports.
- King's Fund: High quality care for all: briefing on NHS Next Stage Review final report.
Trust, assurance and safety: the regulation of health professionals in the 21st century (2007)
This Department of Health White Paper sets out a programme of reform to the United Kingdom's system for the regulation of health professionals. It is complemented by 'Safeguarding patients' - the Government's response to the recommendations of the Fifth Report of the Shipman Inquiry and to the recommendations of the Ayling, Neale and Kerr/Haslam Inquiries. It describes proposals for periodic revalidation of professional registration in which appraisal will be a key component. The processes for this revalidation will come through discussion with each profession and its regulator. Proposals are also made for improving the investigation of concerns about health professionals at local and national levels, and for the extension of information held on professional registers and how this will be managed.
Royal College of Nursing Policy Unit. Policy Briefing 04/2007: Trust, assurance and safety: the regulation of health professionals in the 21st Century (2007) (PDF 52KB)
This briefing presents the RCN view of the proposals made in the white paper, and provides a summary and synopsis of proposals that affect nursing regulation.
Health reform in England: update and commissioning framework (2006)
This document builds on 'Health reform in England: update and next steps' (2005). The focus is on developing first-rate practice-based commissioning to create "an NHS where patients have more choice as well as a real voice in the design of their services".
Our health, our care, our say: a new direction for community services (2006)
This White Paper set a new direction for the whole health and social care system. This involves a radical shift in the way in which services are delivered with the aim of improving access to general practice and community services and providing more services in local settings, and with an increased emphasis on enabling health and independence. Case studies are included.
A summary of the White Paper is available as a brief guide. A report on the progress made with the proposals put forward in the White Paper was published in 2007 as a research report.
Commissioning a patient-led NHS (2005)
This document follows on from the publication of 'Creating a patient-led NHS', and focuses on how the Department of Health will develop commissioning throughout the whole NHS system. The document appears in the Department of Health's web page dedicated to commissioning a patient-led NHS which contains all the key documents and updates on the progress of the NHS in delivering this programme.
Creating a patient-led NHS. Delivering the NHS Improvement Plan (2005)
This document set out how the NHS and the Department of Health will deliver the NHS Improvement Plan. It describes the major changes underway, what patient-led services will look like and what changes will be required for services to become truly patient-led.
Supporting people with long term conditions: an NHS and Social Care Model to support local innovation and integration (2005)
This document describes the NHS and Social Care Model and how it can be implemented. The Model "provides a structured and consistent approach to help local health and social care partners shape the way they deliver integrated long term care locally". It discusses the development of the role of the community matron and the use of case management, improvements in disease management, and how self care can be better supported.
Choosing health: making health choices easier (2004)
This White Paper set out the key principles for supporting the public to make healthier and more informed choices in regards to their health. It presents the outcomes of the public consultation and describes how the Government will provide information and practical support, and improve access to services so that healthier choices are easier to make. See also: Delivering choosing health: making health choices easier (2005).
The NHS Improvement Plan : putting people at the heart of public services (2004)
This document set out the priorities for the NHS between 2004 and 2008 and takes forward the 10-year process of reform first set out in the NHS Plan.
Building on the best: choice, responsiveness and equity in the NHS (2003)
This document develops the main themes emerging from a public consultation process. It sets out the strategy for making the NHS services more responsive to patients and improving the patient experience and increasing choice.
NHS Plan: a plan for investment, a plan for reform (2000)
The NHS Plan sets out the vision for a health service designed around the patient and describes the programme for investment and reform. The document outlines a new delivery system and the changes that will be required to achieve this - changes for staff and patients, and changes in the relationship between health and social care and between the NHS and the private sector.
The new NHS: modern, dependable (1997)
This White Paper formed the basis of a ten year programme to renew and improve the NHS, replacing the internal market of the 1990's with "a system called 'integrated care', based on partnership and driven by performance". It introduced the concept of clinical governance into the NHS requiring "every NHS Trust to embrace the concept of 'clinical governance' so that quality is at the core, both of their responsibilities as organisations and of each of their staff as individual professionals".