Health And Care Standards - NHS Wales

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Health and Care StandardsApril 2015

ForewordForeword by the Minister for Health and Social ServicesOn the 9 July 2013 we gave a commitment to review andupdate the Standards for Health Services in Wales and theFundamentals of Care Standards.During November 2014 to January 2015 we consulted ona revised framework of standards to support the delivery ofhigh quality services in the NHS in Wales. The consultationinvolved a broad range of stakeholders and gatheredtheir views on the changes needed in developing our newHealth and Care Standards. In order to maximise levels ofengagement in the consultation amongst stakeholders andthe public, Welsh Government arranged three consultationevents.The NHS Outcomes and Delivery Framework is one of threeframeworks being published to help drive the continualimprovement in the health and wellbeing of the peopleof Wales, the others relating to social services and public health. It identifies key populationoutcomes and indicators grouped under seven themes. The themes were developed throughengagement with patients, clinicians and stakeholders and identify the priority areas which theywanted the NHS to be measured against. Although each of the three frameworks has its ownseparate function, they all recognise their interconnections and shared measures will be used tosupport partnership working and to deliver improvements in both health and wellbeing.These Health and Care Standards have been designed to fit with the seven themes and theopportunity has also been taken in developing them to identify outcomes relating to socialservices and public health.The Health and Care Standards have also been designed so that they can be implemented inall health care services, settings and locations. They establish a basis for improving the qualityand safety of healthcare services by providing a framework which can be used in identifyingstrengths and highlighting areas for improvement. The public and patients themselves must takeresponsibility for helping the NHS help them through working with it and through taking prudentaction to protect and promote their own health.I am very pleased to commend the Health and Care Standards to you. They further demonstrateour continuous commitment to improving the health and wellbeing of the population of Walesand the quality of the healthcare provided.Mark Drakeford AMMinister for Health and Social Services2Digital ISBN: 978-1-4734-3358-8 Crown Copyright 2015WG 24729

ContentsPart 1PageIntroduction4Legislative Framework4Vision and Principles4Purpose5Terminology6Part 2How the Health and Care Standards are structured7Staying Healthy10Safe Care12Effective Care20Dignified Care25Timely Care28Individual Care29Staff and Resources34Part 3Using the Health and Care Standards36Glossary373

Part 1IntroductionIn 2013, Welsh Government agreed the need for a review of the Doing Well, Doing Better:Standards for Health Services in Wales (2010) and the Fundamentals of Care Standards (2003),which provided an opportunity to align standards underpinning the planning and provision ofhealthcare services. These new Health and Care Standards are designed to be implemented in allhealth care organisations, settings and locations, and by all teams and services.Every person in Wales who uses health services or supports others to do so, whether in hospital,primary care, their community or in their own home has the right to receive excellent care as wellas advice and support to maintain their health. All health services in Wales need to demonstratethat they are doing the right thing, in the right way, in the right place, at the right time and withthe right staff. The Health and Care Standards provide the framework to help teams and servicesdemonstrate this.The public consultation on the revision of the Doing Well, Doing Better: Standards for HealthServices in Wales and the Fundamentals of Care provided an updated and integrated frameworkof standards aimed at helping people in Wales to understand what to expect when they accesshealth services and what part they themselves can play in promoting their own health andwellbeing. They set out the expectations for services and organisations, whether they provide orcommission services for their local citizens, and need to be owned by them.A summary of the main points made in response to the consultation is available on the WelshGovernment website ( en). All responses to theconsultation, including feedback received at the three consultation events, have informed theproduction of these Health and Care Standards.The standards come into force from 1 April 2015 and bring together and update the expectationspreviously set out in “Doing Well Doing Better Standards for Health Services in Wales”, and the“Fundamentals of Care” in conformity with the Health and Social Care (Community Health andStandards) Act 2003.Legislative FrameworkWelsh Ministers are permitted (Section 47 of the Health and Social Care (Community Healthand Standards) Act 2003), to prepare and publish statements of standards in relation to theprovision of health care by and for Welsh NHS bodies. The Welsh Government is required tokeep the standards under review and may publish amended statements whenever it considers itappropriate.Vision and PrinciplesWales has strong systems in place to ensure quality and safety in the NHS. Safe Care,Compassionate Care: A National Governance doc/219549) sets out the expectations thatall services should be patient centred and driven by their needs. This committed Wales to ensurehigh quality, safe care whenever and wherever it is provided by: doing the right things well;4

knowing how well we are doing; being open and honest in all that we do; showing care, compassion and commitment; leading by example.The Welsh Government Quality Delivery Plan for the NHS in Wales (2012 – 17planen.pdf) sets out the clear vision fora quality-driven NHS Wales to achieve the triple aim of: providing the highest possible quality care and excellent experience; improving health outcomes and helping reduce inequalities; getting high value from all our services.The Health and Care Standards will form the cornerstone of the overall quality assurance systemwithin the NHS in Wales. Alongside the Framework for Assuring Service User Experience t/214368) it will help to ensure thatpeople have positive first and lasting impressions, that they receive care in safe, supportive andhealing environments, and that they understand and are involved in their care.Co-production is central to the Social Services and Well Being Act and how health and socialservices are being developed. Everyone, adult or child, has a right and can be given a voice andthe opportunity to be heard as an individual, as a citizen, in helping shape the decisions thataffect them, and to exercise greater control over their day to day lives. This parallels the approachto prudent healthcare which the NHS in Wales is embracing, with its focus on: achievinghealth and well being with the public, patients and professionals as equal partners through coproduction; caring for those with the greatest health need first, making the most effective useof all skills and resources; doing only what is needed and doing no harm, no more, no less; andreducing inappropriate variation using evidence-based practices consistently and transparently.All of the principles outlined above are supported by the Welsh Government’s commitmentdescribed in the strategy ‘More than just Words’ to ensure that access to services through themedium of Welsh becomes a reality for Welsh speaking patients and service users.PurposeThe Health and Care Standards: embrace the principles of co-production and prudent health care; offer a common language to describe what high quality, safe and reliable healthcare serviceslook like; can be used by people of all ages to understand what high quality safe healthcare should beand what they should expect from a well-run service; enable a person-centred approach by focusing on outcomes for service users and driving carewhich places people at the centre of all that the service does;5

Part 1 create a basis for improving the quality and safety of healthcare services by identifyingstrengths and highlighting areas for improvement; can be used in day-to-day practice to encourage a consistent level of quality and safety acrossthe country and across all services; promote practice that is up to date, effective, and consistent; promote accountability of health services to service users, the public and funding agenciesfor the quality and safety of services by setting out how providers should organise, deliver andimprove services; enable people to contribute fully to their own health and wellbeing; recognise the quality standards for other care and support providers issued under the SocialServices Regulation and Inspection Bill currently being considered by the National Assemblyfor Wales.TerminologyPeopleThroughout the Health and Care Standards and supporting guidance the term ‘people’ is used.This is intended to include: those who use healthcare services; their parents, guardians, carers and family; their nominated advocates; potential users of healthcare services.The term ‘people’ is used in general throughout this document but occasionally the term ‘patient’is used where it is more appropriate.Health ServicesThis term is intended to include Welsh NHS bodies, independent contractors, and otherorganisations and individuals including the independent and voluntary sectors, which provide orcommission health services for individual patients, service users and the public of Wales.6

Part 2How the Health and Care Standards are structuredAs figure 1 illustrates below, the seven themes are intended to work together. Collectively, theydescribe how a service provides high quality, safe and reliable care centred on the person.Each theme includes a number of standards. These are not listed in priority order and there issome overlap across themes and standards. There are some standards that do not just standalone but have a much wider influence they are, communicating effectively, quality improvementresearch and innovation, information governance and communications technology, recordkeeping, and people’s ip a n dyEffectiveCareilitGoanSafe CareabGoStayingHealthyTimelyCarernunl it yIndividualCarecc obiStaff andResourcesvenan,ecr s hi p a n dedaALetarFigure 1cocAtnu7

Part 2Person centred care (illustrated in the centre of figure 1) refers to a process that is peoplefocused, promotes independence and autonomy, provides choice and control and is basedon a collaborative team philosophy. It takes into account people’s needs and views and buildsrelationships with family members. It recognises that care should be holistic and so include aspiritual, pastoral and religious dimension. The delivery of person centred care requires both safeand effective care and should result in a good experience for people. This responds to the needexpressed by NHS Wales to be able to describe the key determinants of a “good” experience tohelp both users and providers in assessing how people feel when they receive care and services.Co-production can support the delivery of person-centred care, which prioritises putting patients,their families and carers at the heart of all decisions and plans about health care. It sees patientsas equal partners in planning, developing and assessing care to make sure it is most appropriatefor their needs. Co-production is an approach to public services which involves citizens,communities, and the professionals who support them, pooling their expertise to deliver moreeffective and sustainable outcomes and an improved experience for all involved.The provision of high quality, safe and reliable care is dependent on good governance andleadership, and this is illustrated by placing them around the quality themes labelled asGovernance, Leadership and Accountability.The standard is detailed below:Governance, leadership and accountabilityEffective governance, leadership and accountability in keeping with the size and complexityof the health service are essential for the sustainable delivery of safe, effective personcentred care.The health service will need to consider the following criteria for meeting the standard:Criteria Health services demonstrate effective leadership by setting direction, igniting passion,pace and drive, and developing people. Strategy is set with a focus on outcomes, and choices based on evidence and peopleinsight. The approach is through collaboration building on common purpose. Health services innovate and improve delivery, plan resource and prioritise, developclear roles, responsibilities and delivery models, and manage performance and value formoney. Health services foster a culture of learning and self-awareness, and personal andprofessional integrity.8

The Health and Care Standards are set out in full in the pages that follow.Each Health and Care Standard describes the high-level outcome required to contribute toquality and safety which is person centred and underpinned by governance, leadership andaccountability.There are three sections within each theme: a description of the key principle of the theme, whatit means for a person when the standards within the themes are met, and the criteria for eachstandard. A criteria is defined as a principle or standard by which something may be judged ordecided.A range of supporting guidance to help services meet each standard is available on theNHS Wales Governance e-Manual (

Staying HealthyThe principle of staying healthy is to ensure that people in Wales are well informed to manag

health care organisations, settings and locations, and by all teams and services. Every person in Wales who uses health services or supports others to do so, whether in hospital, primary care, their community or in their own home has the right to receive excellent care as well as advice and support to maintain their health. All health services in Wales need to demonstrate that they are doing .

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