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There aremany organisations that work with the health service to monitor quality withinit. The NHS Outcomes Framework was first introduced in 2011 which developed aset of indicators which measure the performance in the health and care systemat a national-level. They are grouped into five domains, based on the threeelements of the Next Stage Review by Darzi: Domain 1 – ‘Preventing people fromdying prematurely’, Domain 2 – ‘Enhancing quality of life for people withlong-term conditions’, and Domain 3 – ‘Helping people to recover from episodesof ill health or following injury’, all come under ‘effectiveness’; Domain 4 –’Ensuring that people have a positive experience of care comes underexperience’, and Domain 5 – ‘Treating & caring for people in a safe environment& protecting them from avoidable harm’, comes under ‘safety’.

The frameworkuses these domains to provide an overview of how the NHS is performing inEngland and an overall report is written and published each year – this way,the whole service is monitored for its quality.  The NationalInstitute for Health and Care Excellence (NICE) produce quality standards andguidance to improve health and social care in collaboration with professionals,practitioners and service users. These standards are based on sound evidenceand expertise. They also cover a range of conditions and patient groups and,where appropriate, look across the domains and indicators of the NHS OutcomesFramework. The information and advice that is available helps to achieve qualitywithin the health service as it can act as a guide for clinicians whenproviding care. Additionally, the quality standards are used by regulators suchas the Care Quality Commission to help identify and define exceptional care,which is another way of monitoring quality in the NHS. TheCommissioning Outcomes Framework (COF) has been used to measure the quality andoutcomes of healthcare commissioned by Clinical Commissioning Groups (CCG)since April 2013. Its responsibility is to support commissioners in achievingimprovements in outcomes there is also commissioning guidance, as well as toolssuch as standard contracts and payment tariffs.

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This helps commissioners tomeet their commitments and the needs of their local population through thecommissioning and contracting process, ensuring that they purchase the vitalservices. The COF monitors quality within the NHS as it is constantly aware ofthe degree of quality that is being achieved by CCGs, meaning that when lowquality is detected, it can be easily tackled and rectified.  Anotherindependent regulator that is important to the NHS is called the Care QualityCommission (CQC).

The CQC monitors and regulates services by collectinginformation by continual monitoring and during routine inspections of a widerange of services, such as hospitals, care homes, dental practices and othercare services in England, which is then analysed. Monitoring is done to ensurethat fundamental standards of quality and safety are met.  The data is evaluated to ensure that it is ofhigh quality and is as complete as possible.

If the CQC detect low quality carein an establishment, they take action so that all patients are protected fromharm now and in the future. The results are published online on the ‘NHSChoices’ website, where members of the public can view the latest inspectionsand their performance ratings, which can guide them to choose the most safe,efficient and effective care. The ‘NHS Choices’ website is managed by theHealth and Social Care Information Centre (HSCIS) and it provides comprehensiveinformation about general health to enable patients and the public to takecontrol of their own health and make informed choices about things such assmoking, drinking alcohol and other aspects of lifestyle. These services helpto achieve quality within the NHS as they identify which services may bestruggling to reach the high standards that are desired. The NHS hasalways strived to reduce costs whilst improving the quality of care. This isextremely important in the current NHS as the population of England is rapidlyincreasing, meaning that more patients must be cared for.

This means that moremoney and funding is required, which may not be available due to the volume ofdependents (those who aren’t contributing taxes), this puts pressure on thehealth service as a result, as commissioners attempt to get better value fromthe annual NHS budget. However, thinking about the service in terms ofefficiency and cost alone risks losing the opportunity to engage clinical staffin the challenge of changing the way in which care is delivered. These changeswill require commitment from not only leader within the NHS, but also from thegovernment of the United Kingdom, who will help to improve the value overall,thus improving quality. Finally,’Quality Watch’ is a joint research programme which monitors how the quality ofhealthcare changes over time, who believe that there is a need for ‘independentscrutiny’ by non-statutory bodies. This is because many of the organisations thatmonitor the quality of healthcare within the NHS are in fact part of the NHS,which means that there may be some bias when producing final reports based oninspections of particular services. As a result of this, independent charitiessuch as The Nuffield Trust and The Health Foundation have been established.

Both of these organisations aim to improve healthcare in the UK through the useof evidence-based research and analysis. The existence of independent scrutinywill mean that when quality is monitored within the NHS, the conclusions arealways accurate, reliable and fair. To conclude,there are many ways that the NHS and the organisations associated with itattempt to achieve and monitor the quality of its services, as well asincreasing the value of the NHS Budget by improving quality and reducing costs.This is extremely important in the current NHS as the massive population of theUK is rapidly increasing, meaning that there are more dependents that must beprovided for.

Also, the introduction of independent scrutiny will aid the NHSto identify which services are providing the best care and which are strugglingto meet basic standards. 

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