NICE quality standards

• What are NICE quality standards?
• 'Service user experience in adult mental health' quality standard
• Are NICE quality standards enforceable?
• Who creates quality standards?

What are NICE quality standards?

NHS treatment and support in England and Wales should be based on guidance and recommendations issued by the National Institute for Health and Clinical Excellence (NICE) (see What you can expect from the NHS page).

NICE also produces 'quality standards' which are based on its guidance and other relevant evidence. These are statements that describe what 'high-quality' health services should be like. NICE quality standards are relatively new: the idea is that organisations and health professionals can use them to improve the quality of the services they offer, and that patients and their families can refer to them to make sure the treatment, support and care they are being offered meets national standards.

A quality standard describing adult mental health services was published in December 2011 (see below). Quality standards describing the best treatment and services specifically for psychosis and schizophrenia, and the best treatment and services specifically for bipolar disorder are to be developed.

At the moment, NICE quality standards only apply in England.

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'Service user experience in adult mental health' quality standard

This quality standard describes what high quality care should be like for adults with mental health problems who use NHS mental health services. It is called Quality standard for service user experience in adult mental health.

If organisations are offering the best possible quality mental health services, people who use them (and in some instances their family members and other caregivers) should be able to agree with the 15 statements that comprise the quality standard.

The 15 statements are:

1. People using mental health services and their families and carers feel optimistic that care will be effective.

2. People using mental health services and their families and carers feel they are treated with empathy, dignity and respect.

3. People using mental health services are actively involved in shared decision-making and supported in self-management.

4. People using community mental health services are normally supported by staff from a single, multidisciplinary community team, familiar to them and with whom they have a continuous relationship.

5. People using mental health services feel confident that the views of service users are used to monitor and improve the performance of services.

6. People can access mental health services when they need them.

7. People using mental health services understand the assessment process, their diagnosis and treatment options, and receive emotional support for any sensitive issues.

8. People using mental health services jointly develop a care plan with mental health and social care professionals, and are given a copy with an agreed date to review it.

9. People using mental health services who may be at risk of crisis are offered a crisis plan.

10. People accessing crisis support have a comprehensive assessment, undertaken by a professional competent in crisis working.

11. People in hospital for mental health care, including service users formally detained under the Mental Health Act, are routinely involved in shared decision-making.

12. People in hospital for mental health care have daily one-to-one contact with mental health care professionals known to the service user and regularly see other members of the multidisciplinary mental health care team.

13. People in hospital for mental health care can access meaningful and culturally appropriate activities seven days a week, not restricted to 9am to 5pm.

14. People in hospital for mental health care are confident that control and restraint, and compulsory treatment, including rapid tranquillisation, will be used competently, safely and only as a last resort with minimum force.

15. People using mental health services feel less stigmatised in the community and NHS, including within mental health services.

If people who use services cannot agree with these statements, then the organisation, and the mental health professionals who work within it, are not offering the best possible standard of care.

For each quality statement, there is a 'quality measure' and a description of what the statement means in practice for mental health professionals, for commissioners (NHS organisations that plan and 'purchase' services on behalf of people who live within a certain neighbourhood) and for organisations that provide those services.

NICE says organisations should provide evidence to prove that the statements contained in this quality standard describe the experiences of people using the services they provide.

The NICE guidance Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services was issued at the same time as this quality standard. This guideline recommends that service managers should routinely and regularly commission reports on the experience of people who use mental health services, including the experience of people who are being treated under the Mental Health Act. This would provide some of the evidence needed to show that the quality standard is being met.

In some instances, the quality measures that support the quality statements offer specific definitions to guide mental health professionals and organisations. So for example, the quality measures say a crisis plan (referred to in statement 9) should contain:

• possible early warning signs of a crisis and coping strategies;
• support available to help prevent hospitalisation;
• where the person would like to be admitted in the event of hospitalisation;
• the practical needs of the service user if they are admitted to hospital (for example, childcare or the care of other dependants, including pets);
• details of advance statements and advance decisions;
• whether and the degree to which families or carers are involved;
• information about 24-hour access to services
• named contacts.

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Are NICE quality standards enforceable?

According to NICE, the primary purpose of a quality standard is 'to make clear what quality care is by providing patients and the public, health and social care professionals, commissioners and service providers with definitions of high quality health and social care.'

Quality standards are not 'targets' or 'requirements' (so they are not mandatory), but organisations must 'have regard to them' when they plan and deliver services. NICE says organisations that run health services can strive to achieve the quality standards, use them to monitor improvements, and use them to demonstrate to commissioners of services that they provide high quality care.

There is documentation produced by NICE to help organisations that commission NHS services take the quality standards into consideration. It may be in future that those responsible for planning and purchasing NHS care may decide to only commission services from organisations that can prove they meet, or are attempting to meet, the standards.

NICE suggests that organisations responsible for planning, commissioning and providing social care services for adults with mental health problems may also want to use its quality standards. (The Health and Social Care Bill 2011 proposes that in future NICE will also produce quality standards for social care).

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Who creates quality standards?

NICE sets up a group of experts to develop each quality standard. Sometimes this is the same group that is charged with developing NICE guidance: the group that drew up the guidance about people's experience of using mental health services also drafted the quality standard about the same topic.