NICE quality standards: FAQs
- 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 health and social care sectors
Potential audiences for NICE quality standards include:
- Patients, service users, carers and the public
- Health care practitioners
- Public health practitioners
- Social care practitioners
- Service providers
NICE quality standards are central to supporting the Government's vision for a health and social care system focused on delivering the best possible outcomes for people who use services, as detailed in the Health and Social Care Act (2012). Quality standards consider the complete care pathway, across public health, health and social care. Although some standards will be specific to one of these areas, there will often be significant overlap, and this will be considered during development of the standard. Where appropriate, complimentary referrals will be combined and developed as a single fully-integrated quality standard.
The Health and Social Care Act (2012) makes it clear that the Secretary of State, in discharging their duty to improve the quality of services, "must have regard to the quality standards prepared by NICE". Although these standards principally 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.
The primary purpose of NICE quality standards is to describe high-priority areas for quality improvement, which are aspirational but achievable, in a defined care or service area. NICE quality standards do not provide a comprehensive service specification. They define priority areas for quality improvement based on consideration of the topic area.
On occasion, developmental quality statements may be included within a quality standard. These represent emergent areas of practice, supported by NICE guidance or NICE-accredited guidance, that have the potential to lead to wide-spread benefits in improving outcomes over time, but which require specific and significant changes to be put in place.
NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example:
- Patients, service users, carers and the public can use the quality standards as information about what high-quality care or services should include.
- Health care professionals and public health and social care practitioners can use audit and governance reports to demonstrate the quality of care as described in a quality standard, or in professional development and validation.
- Provider organisations and practitioners can use the quality standards to monitor service improvements; to show that high-quality care or services are being provided and highlight areas for improvement; and to show evidence of the quality of care or services as described in a quality standard through national audit or inspection.
- Commissioners can use the quality standards to ensure that high-quality care or services are being commissioned through the contracting process or to incentivise provider performance.
The quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following frameworks:
- NHS Outcomes Framework 2013-14
- Improving outcomes and supporting transparency: Part 1: a public health outcomes framework for England, 2013-2016
- The Adult Social Care Outcomes Framework 2013-14
NICE quality standards and registration requirements
The Care Quality Commission registers 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 in a defined care or service area. The statements and measures in a NICE quality standard together indicate a high quality 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.
Topics will be referred to NICE by NHS England for health-related areas, and by the Department of Health and Department for Education for non-health areas such as social care and public health.
Our process guide sets out in detail the processes involved in managing the development of quality standards in an open, transparent and timely way, with input from individuals and stakeholder organisations. The process guide was consulted on from January to March 2012 and all stakeholder comments have been considered accordingly. Updated versions were published in August 2013and then again in April 2014 due to minor amendments in the quality standards development process.
If you have any questions about NICE quality standards please email QSsupportingorgs@nice.org.uk.
Each NICE quality standard contains a concise set of quality statements (usually 6-8 statements, up to a maximum of 15 statements in exceptional circumstances) and associated measures.
The quality statements can be enhanced or developmental. Generally, quality statements are enhanced statements which describe high priority areas for quality improvement. These statements may address prevention, as well as elements of health and social care, and will promote an integrated approach to improving quality. Occasionally, quality statements are considered to be developmental in nature as they set out emergent areas of practice that have the potential to lead to wide-spread benefits in improving outcomes over time, but which require specific and significant changes to be put in place.
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 and social care 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 Health and Social Care Information Centre through their Indicators for Quality Improvement Programme which can be found at www.hscic.gov.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 care professionals and public health and social care practitioners, commissioners and patients and service users.
Quality Standard Advisory Committees (QSAC) develop the quality standards and are made up of commissioners, GPs and other primary care professionals, experts in quality measurement, public health and social care practitioners, local authority representatives, lay members, secondary care providers and patient safety experts.
At the start of development, a topic overview is produced by NICE which describes key elements of the quality standard, such as the population and condition or services to be covered, and lists the key source guidance that will be used to underpin the quality statements. This is published on the NICE website for a two-week engagement exercise. Registered stakeholders are asked for written submissions identifying key areas for quality improvement, including emergent areas of practice that may be considered to be developmental, highlighting any national or routine indicators and performance measures not listed in the overview and providing examples of published information on current practice to support the identified areas for quality improvement. This can include reports of variation in care or service provision, evaluations of compliance with source guidance or patient, carer or service user experience. Submissions are then presented to the Quality Standards Advisory Committee (QSAC) and help the committee prioritise the areas of quality improvement for which quality statements and measures should be developed.
Consultation involves registered stakeholders making general comments on the draft quality standard during development. In order for your comments to be considered at topic overview engagement and consultation, please register as a stakeholder.
All eligible comments received during consultation will be reviewed by the QSAC and the quality standard under consultation will be refined in line with the QSAC considerations. Please refer to the topics in development page for further information about consultation, including specific issues for consideration.
Please note that NICE no longer responds to consultation comments submitted on NICE quality standards. Instead, following the publication of the quality standard, NICE will provide stakeholders who submitted comments with a link to the minutes of the meeting that will summarise the committee discussions and decisions. In addition, NICE will provide a link to the summary document that was considered by the QSAC.
We would like to thank all those who contributed valuable feedback during the various consultations on the NICE quality standards
Supporting NICE 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 formally supporting a published quality standard to ensure that those commissioning, providing or using services are made aware of and encouraged to use the quality standard.
Organisations who are interested in supporting NICE quality standards must be:
- National patient, service users, carer, voluntary, charity and non-governmental organisations that are run by, or directly reflect the perspectives of people who use services, carers or client groups, and represent the interests of people whose care is covered by the quality standard.
- National organisations that represent the professionals and practitioners who provide the care or services described in the quality standard.
- National organisations that represent commissioners or providers of the care or services described in the quality standard.
- Statutory organisations (an organisation set up by government for a specific purpose) including Ofsted and the Care Quality Commission (CQC).
Further information about supporting NICE quality standards will be available during the draft quality standard consultation phase.
If you have any queries relating to supporting NICE quality standards, please email QSsupportingorgs@nice.org.uk
Get more information on quality initiatives in the health and social care sector from the following sources:
- Care Quality Commission (CQC) (external)
- Department of Health (external)
- The Health and Social Care Information Centre (external)
- Healthcare Quality Improvement Partnership (HQIP) (external)
- NHS England (external)
- Office for Standards in Education, Children's Services and Skills (Ofsted) (external)
- Social Care Institute for Excellence (external)
This page was last updated: 09 April 2014