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The Healthcare Commission is an independent body, set up to promote and drive improvements in the quality of healthcare and public health.

 
The Healthcare Commission has developed a new system for assessing public and private health service in England. The framework for assessment is designed to measure if organisations are getting the basics right and making and sustaining progress.
 
The Standard for Better Health published in July 2004 outlined a common set of standards that all trusts should meet to ensure that they provide services that are safe and of an acceptable quality.
 

There are twenty-four core standards grouped into the following seven domains:

  1. Safety
  2. Clinical and cost effectiveness
  3. Governance
  4. Patient focus
  5. Accessible and responsive care
  6. Care environment
  7. Public Health

Trusts will be requires to undertake a self-assessment against the standards and prepare a public declaration on the extent to which the standards are being met.

Core Standards

1. Safety

 
Domain outcome
 
Patient safety is enhanced by the use of health care processes, working practices and systemic activities that prevent or reduce the risk of harm to patients.
 
Core standards:
 
C1. Health care organisations protect patients through systems that
 
  • Identify and learn from all patient safety incidents and other reportable incidents, and make improvements in practice based and local and national experience and information derived from the analysis of incidents; and
  • Ensure that patient safety notices, alerts and other communications concerning patient safety which require action are acted upon within required timescales.
 
C2. Health care organisations protect children by following national child protection guidance within their own activities and in their dealings with other organisations.
 
C3. Health care organisations protect patients by following NICE Interventional Procedures guidance.
 
C4. Health care organisations keep patients, staff and visitors safe by having systems to ensure that:
  • The risk of health care acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in MRSA;
  • All risks associated with the acquisition and use of medical devices are minimised;
  • All reusable medical devices are properly decontaminated prior to use and that the risks associated with decontamination facilities and processes are well managed;
  • Medicines are handled safely and securely; and
  • The prevention, segregation, handling, transport and disposal of waste is properly managed so as to minimise the risks to the health and safety of staff, patients, the public and the safety of the environment.

2. Clinical and cost effectiveness domain

 

Domain outcome
 
Patients achieve health care benefits that meet their individual needs through health care decisions and services based on what assessed research evidence has shown provides effective clinical outcomes.
 
Core standards:
 
C5. Health care organisations ensure that
  • They conform to NICE technology appraisals and, where it is available, take into account nationally agreed guidance when planning and delivery treatment and care;
  • Clinical care and treatment are carried out under supervision and leadership;
  • Clinicians continuously update skills and techniques relevant to their clinical work; and
  • Clinicians participate in regular clinical audit and reviews of clinical services
           
C6. Health care organisations co-operate with each other and social care organisations to ensure that patients’ individual needs are properly managed and met.

3. Governance domain

 
Domain outcome
 
Managerial and clinical leadership and accountability, as well as the organisation’s culture, systems and working practices, ensure that probity, quality assurance, quality improvement and patient safety are central components of all the activities of the health care organisation.
 
Core standards:
 
C7. Health care organisations
  • Apply the principles of sound clinical and corporate governance;
  • Actively support all employees to promote openness, honestly, probity, accountability and the economic, efficient and effective use of resources;
  • Undertake systematic risk assessment and risk management (including compliance with the controls assurance standards);
  • Ensure financial management achieves economy, effectiveness, efficiency, probity and accountability in the use of resources;
  • Challenge discrimination, promote equality and respect human rights; and
  • Meet the existing performance requirements set out in Appendix 1
           
C8. Health care organisations support their staff through
  • Having access to processes which permit them to raise, in confidence and without prejudicing their position, concerns over any aspect of service delivery, treatment or management that they consider to have a detrimental effect on patient care or on the delivery of services; and
  • Organisational and personal development programmes which recognise the contribution and value of staff and address, where appropriate, under-representation of minority groups.
 
C9. Health care organisations have a systematic and planned approach to the management of records to ensure that, from the moment a record is created until its ultimate disposal, the organisation maintains information so that it serves the purpose it was collected for and disposes of the information appropriately when no longer required.
 
C10. Health care organisations
  • Undertake all appropriate employment checks and ensure that all employed or contracted professionally qualified staff are registered with the appropriate bodies; and
  • Require that all employed professionals abide by relevant published codes of professional practice.
 
C11. Health care organisations ensure that staff concerned with all aspects of the provision of health care
  • Are appropriately recruited, trained and qualified for the work they undertake;
  • Participate in mandatory training programmes; and
  • Participate in further professional and occupational development commensurate with their work throughout their working lives.
 
C12. Health care organisations which either lead or participate in research have systems in place to ensure that the principles and requirements of the research governance framework are consistently applied.

4. PATIENT FOCUS DOMAIN

 
Domain outcome
 
Health care is provided in partnership with patients, their carers and relatives, respecting their diverse needs, preferences and choices and in partnership with other organisations (especially social care organisations) whose services impact on patient well-being.
 
Core standards:
 
C13. Health care organisations have system sin place to ensure that
  • Staff treat patients, their relatives and carers with dignity and respect;
  • Appropriate consent is obtained when required for all contacts with patients and for the use of any patient confidential information; and
  • Staff treat patient information confidentially, except where authorised by legislation to the contrary.
 
C14. Health care organisations have systems in place to ensure that patients, their relatives and carers
  • Have suitable and accessible information about, and clear access to, procedures to register formal complaints and feedback on the quality of services;
  • Are not discriminated against when complaints are made; and
  • Are assured that organisations act appropriately on any concerns and, where appropriate, make changes to ensure improvements in service delivery.
 
C15. Where food is provided, health care organisations have systems in place to ensure that
  • Patients are provided with a choice and that it is prepared safely and provides a balance diet; and
  • Patients’ individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day.
 
C16. Health care organisations make information availability to patients and the public on their services, provided patients with suitable and accessible information on the care and treatment they receive and, where appropriate, inform patients on what to expect during treatment, care and after-care.

5. Accessible and responsive care domain

           
Domain outcome
 
Patients receive services as promptly as possible, have choice in access to services and treatments, and do not experience unnecessary delay at any stage of service delivery or of the care pathway.
 
Core standards:
 
C17. The views of patients, their carers and others are sought and taken into account in designing, planning, delivering and improving health care services.
 
C18. Health care organisations enable all members of the population to access services equally and offer choice in access to services and treatment equitably.
 
C19. Health care organisations ensure that patients with emergency health needs are able to access care promptly and within nationally agreed timescales, and all patients are able to access services within national expectations on access to services.

6. Care environment and amenities domain

           
Domain outcome
 
Care is provided in environments that promote patient and staff well-being and respect for patients’ needs and preferences in that they are designed for the effective and safe delivery of treatment, care or a specific function, provide as much privacy as possible, are well maintained and are cleaned to optimise health outcomes for patients.
 
Core standards:
 
C20. Health care services are provided in environments which promote effective care and optimise health outcomes by being:
 
  • A safe and secure environment which protects patients, staff, visitors and their property and the physical assets of the organisation; and
  • Supportive of patient privacy and confidentiality.
 
C21. Health care services are provided in environments which promote effective care and optimise health outcomes by being well designed and well maintained with cleanliness levels in clinical and non-clinical areas that meet the national specification for clean NHS premises.

7. Public health domain

           
Domain outcome
 
Programmes and services are designed and delivered in collaboration with all relevant organisations and communities to promote, protect and improve the health of the population served and reduce health inequalities between different population groups and areas.
 
Core standards:
 
C22. Health care organisations promote, protect and demonstrably improve the health of the community serviced and narrow health inequalities by
  • Co-operating with each other and with Local Authorities and other organisations;
  • Ensuring that the local Director of Public Health’s Annual Report informs their policies and practices; and
  • Making an appropriate and effective contribution to local partnership arrangements including Local Strategic Partnerships and Crime and Disorder Reduction Partnerships.
 
C23. Health care organisations have systematic and managed disease prevention and health promotion programmes which meet the requirements of the National Service Frameworks and national plans with particular regard to reducing obesity through action on nutrition and exercise, smoking, substance misuse and sexually transmitted infections.
 
C24. Health care organisations protect the public by having a planned, prepared and, where possible, practised response to incidents and emergency situations which could affect the provision of normal services.

Developmental Standards

 
The developmental standards are designed for a world in which patients expectations are increasing and in which the public has a right to expect improvements to service as a result of extra investment of money in the NHS. Patients expect the basics are being met and expect those providing healthcare to be striving for excellence.

1. Safety

 
Domain outcome
 
Patient safety is enhanced by the use of health care processes, working practices and systemic activities that prevent or reduce the risk of harm to patients.
 
Developmental standard:
 
D1. Health care organisations continuously and systematically review and improve all aspects of their activities that directly affect patient safety and apply best practice in assessing and managing risks to patients, staff and others, particularly when patients move from the care of one organisation to another

2. Clinical and cost effectiveness domain

 
Domain outcome
 
Patients achieve health care benefits that meet their individual needs through health care decisions and services based on what assessed research evidence has shown provides effective clinical outcomes.
 
Developmental standards:
 
D2. Patients receive effective treatment and care that:
  • conform to nationally agreed best practice, particularly as defined in National Service Frameworks, NICE guidance, national plans and agreed guidance on service delivery;
  • take into account their individual requirements and meet their physical, cultural, spiritual and psychological needs and preference;
  • are well co-ordinated to provide a seamless service across all organisations that need to be involved, especially social care organisations; and
  • is delivered by health care professionals who make clinical decisions based on evidence-based practice

3. Governance domain

 
Domain outcome
 
Managerial and clinical leadership and accountability, as well as the organisation’s culture, systems and working practices, ensure that probity, quality assurance, quality improvement and patient safety are central components of all the activities of the health care organisation.
 
Developmental standards:
 
D3. Intergrated governance arrangements, representing best practice, are in place in all healthcare organisations and across all health communities and clinical networks.
 
D4 Healthcare organisations work together to:
  • ensure that the principles of clinical governance are underpinning the work of every clinical team and clinical service;
  • implement a cycle of continuous quality improvement; and
  • Ensure effective clinical and managerial leadership and accountability.
 
D5. Healthcare organisations work together, and social care organisations, to meet the changing needs of their population by:
  • having an appropriate constituted workforce with an appropriate skills mix across the community; and
  • Ensuring the continuous improvement of services through better ways of working.
 
D6. Healthcare organisations use effective and integrated information technology and information systems which support and enhance the quality of patient care, choice and service planning.
 
D7. Health care organisations work to enhance patient care by adopting best practice in human resources management and continuously improving staff satisfaction.

4. Patient focus domain

 
Domain outcome
 
Health care is provided in partnership with patients, their carers and relatives, respecting their diverse needs, preferences and choices and in partnership with other organisations (especially social care organisations) whose services impact on patient well-being.
 
Developmental standards:
 
D8. Health care organisations continuously improve the patient experience, based on the feedback of patients, carers and relatives.
 
D9. Patients, service users and, where appropriate, carers receive timely and suitable information, when thy need and want it, on treatment, care, service, prevention and health promotion and are
  • encouraged to express their preference; and
  • supported to make choices and shred decisions about their own health care.
D10. Patient and service users, particularly those with long term conditions, are helped to contribute to planning of their care and provided with opportunities and resources to develop competence in self-care.

5. Accessible and responsive care domain

           
Domain outcome
Patients receive services as promptly as possible, have choice in access to services and treatments, and do not experience unnecessary delay at any stage of service delivery or of the care pathway.
 
Developmental standards:
D11. Health care organisations plan and deliver health care which
  • reflects the views and health needs if the population served and which is based on nationally agreed evidence of best practice; and
  • maximises patient choice;
  • ensures access (including equality of access) to services through a range of providers and routes of access; and
  • uses locally agreed guidance, guidelines or protocols for admission, referral and discharge that accord with the latest national expectations on access to service.

6. Care environment and amenities domain

           
Domain outcome
Care is provided in environments that promote patient and staff well-being and respect for patients’ needs and preferences in that they are designed for the effective and safe delivery of treatment, care or a specific function, provide as much privacy as possible, are well maintained and are cleaned to optimise health outcomes for patients.
 
Developmental standards:
D12. Health care is provided in well designed environments that
  • promote patient and staff well being, and meet patients needs and preferences, and staff concerns; and
  • are appropriate for the effective and safe delivery of treatment, care or a specific function, including the effective control of health care associated infections.

7. Public health domain

           
Domain outcome
Programmes and services are designed and delivered in collaboration with all relevant organisations and communities to promote, protect and improve the health of the population served and reduce health inequalities between different population groups and areas.
 
Developmental standards:
D13. Health care organisations
  • identify and act upon significant public health problems and health inequality issues, with Primary Care Trusts taking the leading role;
  • implement effective programmes to improve health and reduce health inequalities;
  • protect their population from identified current and new hazards to health; and
  • take fully into account current and emerging policies and knowledge on public health issues in the development of their public health programmes, health promotions and prevention services for the public, and commissioning and provision of service.
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