England - National standards and key strategies

Most of the documents below are in PDF format - see how to access PDF files

National standards

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.

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 safey of care are listed at The essential standards.
A separate website containing 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.

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:

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.

Key strategies

You can also find related policy and reports within each of the six themes. View the six themes on the homepage.

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.
Nursing and Care Quality Forum mission statement (PDF 18.7KB).
The first meeting of the Forum was held on 17 April 2012 and the RCN attended this first meeting.

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 King's Fund provides analysis and briefings on the different stages of the Bill and the resulting Act at King' Fund: Health and Social Care Act and in April 2012 published a reading list on the NHS reforms.

See also: RCN Briefing: Health and Social Care Bill 2011 (Report Stage and Third Reading briefing) (PDF 102.67KB).

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.
See also RCN welcomes NHS Future Forum report.

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.

An RCN briefing on the NHS White Paper around the key themes is available – see: RCN Policy Unit Policy briefing 09/2010 A summary of the NHS White paper and some key issues and questions for nurses and nursing to consider as part of the consultation (PDF 101KB).

The Royal College of Nursing has responded to the NHS White Paper and says the scale and speed of reforms pose a significant risk to the future of the NHS in England. For the full response, an executive summary and responses to consultation documents directly related to the main White Paper see NHS White Paper ‘Equality and excellence: Liberating the NHS’: RCN response (PDF 101.3KB).

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
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 section of the Department of Health provides background information on quality accounts, describes their purpose and points to advice to NHS providers on how to set out their quality accounts. 

NHS Constitution for England (2010 edition)
Ths NHS Constitution was developed as part of the NHS Next Stage Review led by Lord Darzi, and published on the 21st January 2009. It aims to 'protect and renew the enduring principles of the NHS'. It will empower staff, patients and the public by setting out existing legal rights and pledges for the first time in one place and in clear and simple language. It also sets out clear expectations about the behaviours and values of all organisations providing NHS care. This Department of Health web page brings together key documents related to the NHS Constitution.

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.  In particular these include the Transforming community service best practice guides for six service areas which are to be used alongside the Quality framework for community services.

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 as a "once in a generation opportunity to ensure that a properly resourced NHS is clinically-led, patient-centred and locally accountable" (Department of Health 2007). 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:

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 sets 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 sets 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.

Delivering choosing health: making health choices easier (2005)
This delivery plan, published in March 2005, outlines how the commitments identified in the public health white paper 'Choosing health' will be delivered at national, regional and local level across all sectors. It identifies key interventions and best practice - 'big wins' - that are most likely to improve health.

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 sets 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. Further commentary last updated in February 2005 is at Choosing Health White Paper.

National standards, local action. Health and social care standards and planning framework 2005/6 - 2007/8. (2004)
This document sets out a framework for all NHS organisations and local authorities to use in planning, commissioning and delivering services and setting targets for 2005-2008. It is  based around the 'Standards for better health' which are included within the document.

The NHS Improvement Plan : putting people at the heart of public services (2004)
This document sets 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".