NICE quality standards: improving healthcare quality in the English NHS?

The UK's National Institute for Health and Care Excellence (NICE) is best known in primary care for its production since 2001 of evidence-based clinical guidelines covering a wide range of clinical conditions. 1 More recently, NICE guidelines have become further integrated into UK primary care through their development into performance measures for the Quality and Outcomes Framework (QOF) payment for performance scheme. 2 NICE have, however, been developing other quality improvement guidance over the last few years and a key aspect of their current work programme is the development of quality standards for healthcare, social care and public health. 3 NICE were first tasked to develop quality standards for the English National Health Service (NHS) in the Darzi Review of 2008 and the first four standards were developed in 2009/10 using a pilot process that drew upon the existing methods of NICE clinical guideline development. 4 In 2010, the profile of NICE quality standards was raised significantly with the new coalition government emphasising the centrality of NICE quality standards in the 'new NHS' in its 2010 policy paper Liberating the NHS and in the subsequent 2012 Health and Social Care Act. 5,6 As of June 2013, NICE have published 32 quality standards (30 health-care; two social care) and have a further 29 standards in development. In terms of answering the question 'what is a healthcare quality standard?', there exists no standard definition in the same way that there is an accepted definition of a clinical practice guideline. 7,8 Nonetheless, it is generally agreed that a standard should be a measurable aspect of healthcare quality. A target standard may be set prospectively and stipulate a level of care that providers must strive to meet. An achieved standard can be measured retrospectively and details whether a care provider met a predetermined standard. 9,10 Such standards can be minimally acceptable standards to ensure safe practice, or be 'optimal' or aspirational standards designed to encourage and support a move to better practice. 7 NICE quality standards aim to provide clear descriptions of high priority areas for quality improvement in a defined care or service area with the standards being described as being 'aspirational but achievable'. 11 They can thus be seen as being 'optimal' standards. 7 The need for standards to be measurable is reflected in the fact that each standard contains a concise number (six to eight) of quality statements with accompanying quality …