for health, vowed this week.
Mr Dobson was launching an annual programme of national service frameworks which will, for the first time ever, lay down the type and standards of NHS care that patients can expect in every part of the country.
'I am determined to get rid of the inconsistencies and unacceptable variations so that patients can get a guaranteed high standard of treatment in all parts of the country.
'The first two new areas to be covered by national service frameworks - from 1st April 1999 - are coronary heart disease and mental health. They will draw on the experience of the Calman/Hine framework already laid down for a national cancer service and the framework that I launched last July for children's intensive care. It will mean we have national service frameworks in place for three of the main priority areas spelt out in our Green Paper 'Our Healthier Nation'.
'Coronary heart disease is a major cause of early death. About 18,000 men and 7,000 women die of it before they reach 65. I am delighted that Professor George Alberti, President of the Royal College of Physicians, has agreed to co-chair the group leading this work.
'So far as mental health is concerned, 20 per cent of women and 14 per cent of men will experience a mental health problem at some time in their lives.'
Mr Dobson said:
'These frameworks aren't statements of pious hope. Each of them will spell out the practical arrangements which will be put in place to prevent and treat the various conditions they cover. We will establish national service frameworks for all major areas of healthcare and different types of illness and disease, so there is much work to do.
'The Government intends to work with healthcare professionals, carers, and users of the NHS and social services. That is why I am today inviting views on what other areas should be the subject of national service frameworks.'
NATIONAL SERVICE FRAMEWORKS
1. The new NHS set out a package of measures to drive up the
quality of services to patients including the introduction of
National Service Frameworks.
2. National Service Frameworks will set national standards and
define service models for a defined service or care group; put in
place strategies to support implementation; and establish performance
measures against which progress within anagreed timescale will be
measured. The Commission for Health Improvement will assure progress
through a programme of systematic service reviews.
3. The initial programme of work will take forward the existing
frameworks for cancer and paediatric intensive care, and will begin
to develop new National Service Frameworks for mental health and
coronary heart disease. Emerging findings will be published in the
autumn, and the NHS, working with partner agencies, will be expected
to begin to plan for implementation from April 1999.
Developing National Service Frameworks
4. The Government's White Paper, The new NHS, was a landmark
statement for the future of the NHS. It set out the Government's
plans for modernising the health service and delivering a better
service to patients, through improved quality and efficiency,
offering prompt high quality treatment and care built around the
needs of individuals. A consultation document on Quality will be
issued in late Spring, and will take forward a range of proposals to
improve the quality of health care. These include the establishment
of a rolling programme of National Service Frameworks.
5. The initial programme of work will take forward the frameworks
for cancer and paediatric intensive care, and begin to develop new
National Service Frameworks for mental health and coronary heart
6. The main focus for mental health will be adults of working age.
But the complex needs of those graduating from adolescence and into
old age will also be addressed, as will the link to children's
services in terms of successful mental health promotion strategies.
7. Within coronary heart disease the focus will be on the role of
the NHS working directly and in partnership with others, especially
local authorities, and will include significant elements of health
promotion and disease prevention.
8. Mental health and coronary heart disease will be identified as
medium term priorities for the NHS in the statement of priorities for
1999/2000. Their priority status will also be reflected in guidance
on Health Improvement Programmes .
9. Each National Service Framework will be developed with the
assistance of an expert reference group which will bring together
health professionals, service users and carers, health service
managers, partner agencies, and other advocates. The reference
groups will adopt an inclusive process to engage the full range of
views. The Department of Health will support the reference groups
and manage the overall process.
10. To set national standards and define service models, each
National Service Framework will include an assessment of the health
and social care needs to be addressed; the evidence on effective and
efficient interventions and organisational arrangements; the present
position and the issues to be tackled; resource implications; and the
timescale for change.
11. In order to enable implementation the national standards will be
underpinned by a clear statement ofthe evidence base. This will
draw on existing research, and may require further work to be
commissioned. This will be disseminated, for example through the
clinical guidelines and clinical audit methodologies which the
National Institute of Clinical Excellence will provide.
Implementation will be further supported through workforce
strategies, information development and organisational development.
12. Finally the National Service Frameworks will include performance
measures against which progress will be assessed, for example,
through the NHS performance management framework; through the
programme of systematic service reviews which we propose will be
undertaken by the Commission for Health Improvement, and through the
new NHS Charter.
13. The reference groups for mental health and coronary heart
disease will be established during the next few weeks, and will begin
work in the early Summer.
14. Emerging findings on coronary heart disease and mental health
will be available in Autumn 1998, prior to publication of the
National Service Frameworks in Spring 1999. This will enable health
authorities, together with their partners including local
authorities, to begin to plan through their Health Improvement
Programmes for implementation from April 1999. It is anticipated
that partnership with local government in particular will be crucial
to the overall achievement of progress on both mental health and
coronary heart disease.
15. Both coronary heart disease and mental health are targets in Our
Healthier Nation. The National Service Frameworks will inform the
NHS elements of the national contracts which the Green Paper
16. Further candidates for the rolling programme of National Service
Frameworks are currently under consideration and suggestions for the
next tranche of the programme are invited. There will usually be only
one new topic every year. The criteria which will inform selection
of topics for future service frameworks will include:
- demonstrable relevance to the Government's agenda including Our
- an important health issue in terms of mortality, morbidity,
disability or resource use
- an area of public concern
- evidence of a shortfall between actual and acceptable practice
with real opportunities for improvement
- an area where care pathways are complex
- a need for service improvement that may require significant
- a problem which requires new, innovative approaches
17. If you have queries on this letter or wish to propose future
topics for National Service Frameworks please write to:
Health Services Directorate
133 Waterloo Road