More information about the NICE quality standards

• Who are NICE quality standards for?
• What is the purpose of NICE quality standards?
• How are topics selected?
• How are NICE quality standards developed?
• What makes up a NICE quality standard?
• How can I get involved?
• More information about quality initiatives within the NHS
• Frequently asked questions

Who are quality standards for?

Potential audiences for NICE quality standards include:

• Patients, carers and the public
• Health care professionals
• Public health practitioners
• Social care professionals
• Commissioners
• Service providers

What is the purpose of NICE quality standards?

The NHS White Paper Equity and Excellence: Liberating the NHS (2010) describes NICE's quality standards as crucial to the delivery of a high quality outcomes focused NHS in England: "to achieve our ambition for world-class healthcare outcomes, the service must be focused on outcomes and the quality standards [developed by NICE] that deliver them" and proposes that up to 150 of these should be developed by NICE over 5 years.

The primary purpose of NICE quality standards is to make it clear what quality care is by providing patients, carers and the public, health and social care professionals, commissioners and service providers with definitions of high-quality health and social care.

NICE quality standards provide a clear description of what a high-quality service looks like so organisations can improve quality and achieve excellence. They should support benchmarking of current performance against evidence-based measures of best practice to identify priorities for improvement.

NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example:

• Patients, carers and the public can use the NICE quality standards to provide information about the quality of care they should expect to receive from their healthcare provider.
• Health and social care professionals and public health practitioners can use the quality standards in clinical audit and governance reports or in professional development and validation.
• Provider organisations can use the quality standards to provide high quality services for patient care and to monitor quality improvements, to show through Quality Accounts that high-quality care is being provided and highlight areas for improvement, or to show successful performance in a national audit or inspection.
• Commissioners may use the quality standards to ensure that high quality care is being commissioned through the contracting process or to incentivise provider performance by using the indicators in association with incentive payments such as Commissioning for Quality Improvement (CQUIN).

The Health and Social Care Act (2012) makes it clear that the Secretary of State, in discharging their duty to improve the quality of health services, "must have regard to the quality standards prepared by NICE". Although these standards set out aspirational but achievable care and are not targets, the care system should also have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

It is proposed that the standards will be mapped to the domains of quality in the NHS Outcomes Framework and Social Care Outcomes Framework where relevant, which incorporate clinical effectiveness, patient experience and patient safety. Future NICE quality standards will be developed with the Coalition Government's vision to focus more on outcomes as presented in the NHS Outcomes Framework and Social Care Outcomes Framework in mind.

• Advice on the NICE quality standards from the Department of Health

NICE quality standards and registration requirements

The Care Quality Commission register providers of health and adult social care in England, ensuring that they meet essential standards of quality and safety set out in the Governments Registration Regulations.

NICE quality standards define what high quality care should look like. The statements and measures in a NICE quality standard together indicate a high quality clinical service. The delivery of high quality care is signalled by good performance across the breadth of all statements and measures.

If an organisation is performing poorly on many or all measures, it may mean that an organisation is at risk of not meeting CQC's Essential Standards of Quality and Safety and of not complying with regulatory requirements. CQC may make use of data on Quality Standards measures in their risk estimation.

The Care Quality Commission will also look to align any special reviews and studies it undertakes with quality standards that have been developed and relate to the particular aspect of care being looked at as part of the review or study.

How are topics selected?

Topics for development as NICE quality standards are currently selected by the National Quality Board's Prioritisation Committee, with referral by ministers. The National Quality Board, which has stakeholders from across health and social care, was established to champion quality and ensure the quality system is aligned throughout the NHS. The National Quality Board's Prioritisation Committee considers clinical prioritisation in detail and then advises ministers on which topics should be commissioned from NICE as quality standards.

Following the engagement exercise in summer 2011 NICE has now received referral of the library of topics for quality standards development.

How are NICE quality standards developed?

We consulted in the propose update to the Developing NICE quality standards: interim process guide in Spring 2012. Consultation closed on 13 March. All eligible comments will now be reviewed by the NICE quality standards team and the process guide will be updated accordingly.

If you have any questions about NICE quality standards please email qualitystandards@nice.org.uk.

What makes up a NICE quality standard?

Each NICE quality standard contains up to 15 specific, concise statements and associated measures.

The quality statements describe key markers of high-quality, cost-effective care for a particular clinical condition or pathway. These statements may address prevention, as well as elements of health and social care, and will promote an integrated approach to improving quality.

Quality measures accompany the quality statement and aim to improve the structure, process and outcomes of health and social care. They are not a new set of targets or mandatory indicators for performance management.

All quality measures are specified in the form of a numerator and a denominator which define a proportion (numerator/denominator). It is assumed that the numerator is a subset of the denominator population.

For instance, using Chronic Kidney Disease (CKD) as an example, if the quality measure is:

• Numerator - the number of people in the denominator receiving testing for CKD.
• Denominator - the number of people with risk factors for CKD.

The proportion is the number of people with risk factors for CKD who receive testing for CKD. The numerator does not include those receiving testing for CKD who do not have risk factors for CKD.

At present there are limited health outcome measures that can be used as quality measures. Therefore, the focus of the quality measures is on improving the processes of care that are considered to be linked to health outcomes.

The quality standard also indicates where national quality assured indicators currently exist and measure the quality statement. National indicators include those developed by the NHS Information Centre through their Indicators for Quality Improvement Programme which can be found at www.ic.nhs.uk.

Where national quality indicators do not exist, the quality measures should form the basis for audit criteria developed and used locally to improve the quality of health care. As part of developing these audit criteria the audit standards or levels of expected achievement should, unless otherwise stated, be decided locally

In addition the quality standard offers audience descriptors of what the quality standards mean for different audiences: service providers, health and social care professionals, commissioners and patients

NICE quality standards and the Commissioning Outcomes Framework (COF)

The Government's response to the recent consultation on the White Paper, Equity and Excellence: Liberating the NHS, made clear that NICE will support the NHS Commissioning Board to develop the Commissioning Outcomes Framework (COF) and that NICE quality standards would be reflected within this framework.

We have been asked by the Department of Health to examine all of the NICE quality standards that were published by April 2011 and to undertake further work on these standards in order to develop indicators for consideration by the NHS Commissioning Board for potential inclusion within the COF.

We have recruited an independent advisory committee to consider these indicators and to advise on which should be developed further for consideration in due course by the NHS Commissioning Board. For further information please see the COF web pages.

How can I get involved?

Topic Expert Groups develop the quality standards and are made up of health and social care professionals, commissioners, patients and carers. For more information on joining a Topic Expert Group please visit Join a NICE committee or working group.

Consultation involves a wider range of registered stakeholders making general comments on the draft quality standard during development via the NICE website. In order for your comments to be considered, please register as a stakeholder.

All eligible comments received during consultation will be reviewed by the Topic Expert Groups and the quality standard under consultation will be refined in line with the Topic Expert Group considerations. Please refer to the topics in development page for further information about consultation, including specific issues for consideration.

We would like to thank all those who contributed valuable feedback during the various consultations on the NICE quality standards.

Endorsing NICE's quality standards: organisations who share NICE's commitment to ensuring that quality improvement in a topic area is based on evidence-based guidance will be provided with an opportunity to express interest in endorsing a published quality standard to achieve maximum dissemination.

Organisations who are interested in endorsing NICE quality standards must be:

• National patient, carer, voluntary, charity and non-governmental organisations that are run by, or directly reflect the perspectives of patients, service users, carers or client groups, and represent the interests of people whose care is covered by the quality standard in England.
• National organisations that represent the healthcare professionals who provide the services described in the quality standard in England.
• Statutory organisations (an organisation set up by government for a specific purpose) including Ofsted, NHS Institute for Innovation and Improvement, Health Protection Agency, National Screening Committee, Joint Committee on Vaccination and Immunisation, National Patient Safety Agency and Local Government Improvement and Development.

Further information about endorsing NICE quality standards will be available during the draft quality standard consultation phase.

Read the NICE disclaimer for information on the use and accuracy of content on the NICE website.

More information about quality initiatives within the NHS

Get more information on quality initiatives in the NHS from the following sources:

• NHS Information Centre (external)
• Department of Health (external)
• National Patient Safety Agency (NPSA) (external)
• Healthcare Quality Improvement Partnership (HQIP) (external)
• Social Care Institute for Excellence (external)

Frequently asked questions

• FAQ document