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Access to high-quality NHS care and treatment will be guaranteed whoever you are, wherever you live, and whatever y...
Access to high-quality NHS care and treatment will be guaranteed whoever you are, wherever you live, and whatever your sex, your income, or the colour of your skin, Frank Dobson, secretary of state

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.

He said:

'I am determined to improve quality in the NHS, and to make sure that everyone - wherever they live, and whatever their circumstances - has access to services of uniformly high quality. I am building on the foundations we laid last December, in the White Paper 'The New NHS - Modern: Dependable', and creating a single National Health Service which is administered locally, but which offers treatment on a fair basis to people in need right across 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.'




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.

Next Steps

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


Future Work

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

Healthier Nation

- 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:

Gillian Chapman

Health Services Directorate

NHS Executive

Room 318

Wellington House

133 Waterloo Road



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