NICE issues the first of 150 quality standards for the NHS

BMJ 2010; 341 doi: (Published 01 July 2010) Cite this as: BMJ 2010;341:c3536
  1. Deborah Cohen
  1. 1BMJ

    Patients who have had a stroke should be offered at least 45 minutes of active therapy for at least five days a week, new guidance to drive up the quality of care in dementia, stroke, and venous thromboembolism has said.

    The guidance, from the National Institute for Health and Clinical Excellence (NICE), is the first of 150 evidence based quality standards in different areas of health care, developed as part of NICE’s new Quality Standards Programme. Its guidance on neonatal care is expected in the autumn.

    Other measures include ensuring people with dementia receive care from health and social care staff who have been adequately trained in dementia care. And patients and carers receive verbal and written information and advice on venous thromboembolism prevention at the time of admission and discharge.

    Andrew Lansley, the health secretary, broadly welcomed the guidance. “Quality standards give an authoritative statement on what high quality NHS health care should look like in relation to dementia, stroke, and venous thromboembolism. It will, in future, support a service that is focused on outcomes and looks for the evidence on how to achieve continuously improving outcomes,” he said.

    Nevertheless, he denied that these were a new set of targets and he said he would not tell clinicians how to achieve the outcomes.

    The guidelines will form a “consistent set of measures” that will be the basis—rather than volume and price—of commissioning led by the soon to be formed GP commissioning consortiums. They will also be used in designing incentives and for inspection by the Care Quality Commission. Guidance about commissioning using these measures is being drafted.

    Although he admitted activity was still relevant and waiting times might still be important as part of a quality measure—for example, the time taken for a fractured neck of femur being operated on when someone presents to the emergency department—Mr Lansley said quality had been overlooked.

    Even though Mr Lansley denied that the government was going to set process targets, he did concede that doctors and commissioners of health care had to be clear about what processes were needed to drive up quality. Specifics in the guidance include receiving brain imaging within an hour of arrival at hospital if a stroke is suspected; and follow-up by specialist stroke rehabilitation services within 72 hours after discharge.

    Not only should commissioners be “performance managing” to look for improvement of services, patients will also be able to hold the NHS to account, he said. The guidance is accompanied by information detailing what patients and carers should expect. And with information publicly available from the NHS Information Centre about quality standards, it will help patients to choose their provider, he said.

    Although the panel started work on the guidance under the last government in April 2009, it is clear that Mr Lansley sees it as part of his government’s development of an outcomes framework for the NHS.

    Members of the panel said that this was a way of cutting through the sea of standards and guidance already available, and that it would provide definitive evidence around which to organise the NHS.

    Although there is no clear time frame for implementation, Andrew Dillon, chief executive of NICE said that some centres may be achieving the standards already whereas others would have much further to go, and would need to invest resources to get there.

    Costs would be balanced by the improvement in care. For example, if the wrong treatment is given in a stroke this could result in expensive long term nursing care. And an estimated £200m (€243m; $300m) is spent on inappropriate dementia care. It is hoped that this guidance would prevent this.


    Cite this as: BMJ 2010;341:c3536

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