Yana Richens // National Service Frameworks and Strategy Documents

National Service Frameworks and Guidance

National service frameworks (NSF’s) have been established to improve services by setting National Standards, their aim is to reduce variations in care and improve the quality of care provided based upon the best available evidence. Each country has its own National Service Framework, although they may vary slightly from country to country what they have in common is that they all aim to detect, treat plan and manage services under one umbrella

An action plan which aims to tackle widespread inequalities in
health across England. 'Health Inequalities - A Programme for Action' provides detailed ways for local organisations to change the way they deliver services to improve the health of disadvantaged groups.

More information on the programme and access to the full plan is available via the Programme for Health.

The Programme for action includes a review on health inequalities; ensuring departments deliver on their commitments and that local action reflects this agenda.

It provides the basis for meeting the 2010 national health inequalities target on life expectancy (by geographical area) and infant mortality (bysocial class) by building on current work, and addressing the wider causes
of inequalities in the years beyond.

The Programme is organised around four themes to enable action on a broad
front:

+ Supporting families, mothers and children - to ensure the best possible

start in life and break the inter-generational cycle of health

+ Engaging communities and individuals - to ensure relevance, responsiveness

and sustainability

+ Preventing illness and providing effective treatment and care-making

certain that the NHS provides leadership and makes the contribution to

reducing inequalities that is expected of it

+ Addressing the underlying determinants of health - dealing with the long

term underlying causes of health inequalities

The Department of Health's Health Inequalities Unit will be responsible for monitoring the work across Government to tackle health inequalities.

In launching the plan Health Secretary [for England] John Reid said that glaring gaps between different parts of the country and different groups within it have been tolerated for too long.

"Why should we accept that a man born in Manchester can expect to live, on average, ten years less than one born in Dorset and that a woman born in Manchester is likely to live seven years less than a woman born in West Somerset?"

"And why should we accept that manual workers and some ethnic minorities appear condemned to suffer worse health just through an accident of birth? These differences are not only unfair - they are avoidable," he said.

The action plan covers not just the NHS but local authorities, social services, education, planning and employment.

The Government aims to reduce inequalities in health outcomes by 10 per cent by 2010.

Buckinghamshire Health Authority published a report in 1999 investigating the causes of prenatal mortality in the South Asian community in Buckinghamshire and Milton Keynes. The authors question, whether ethnicity is the cause of significant disadvantage in areas which have comparatively low ethnic minority populations, or whether ethnicity is a greater problem in these areas because there are small minority ethnic populations which maybe overlooked. According to 1991 Census data the non-white population in Buckinghamshire was 5.2%, and South Asians made up 2.5% of the population in the county. Prenatal mortality rates were significantly higher in South Asian mothers (23.7 per 1000 births) compared to white mothers (4.8 per 1000births). Recommendations on improving collection of ethnicity data, reviewing the role of the link worker, access to genetic counselling and specialist anomaly screening for South Asian families, and an awareness of an action against institutional racism within the NHS were made. Although the report is some years old, Reps may find the publication a useful starting point for tackling inequalities in prenatal mortality rates in their area. If one MSLC can commission this kind of detailed local review and a strategy for action, then others should be able to do the same.

The National Institute for Clinical Excellence and the National Collaborating Centre for Women’s and Children’s Health have published a guideline for the NHS in England and Wales on the routine care of healthy pregnant women.

To access a PDF of the document please see: National Institute for Clinical Excellence.

An overview of the strategy for quality in the NHS

National Standards and Guidelines

National Institute for Clinical Excellence (NICE) (Not Scotland) - provides patients, health care professionals and the public with robust and reliable guidance on current best clinical practice.

Scottish Inter-Collegiate Guidelines Network (SIGN) – provides guidance on best practice for Scotland.

National Service Frameworks (Not Scotland) – are national standards that define service models for a specific service or care group (for example cancer care).

Local Implementation

Clinical Governance (as above)

Professional Self Regulation

Lifelong Learning

External Evaluation and Monitoring

Commission for Health Care Audit and Information (CHAI) for England, Wales and by invitation in Northern Ireland (Not Scotland) - CHAI’s role is to assess the clinical governance arrangements of every NHS organisation, investigate where there is serious failure, check the NHS is following national guidelines and advise the NHS on best practice.

Clinical Standard’s Board for Scotland National Performance Framework (Not Scotland)

Ref: Adapted from Clinical Governance: RCN(2003)

For more information on policy developments in the NHS, see The New NHS: Modern, Dependable (DoH 1997) and Delivering the NHS Plan (DoH 2002).