The national service frameworks (NSFs) are ten-year, government, initiatives that aim to ensure major health issues and diseases are tackled effectively and consistently across England and Wales.

NSFs set out what patients can expect from the health service in a major care area or disease group and specify appropriate services in primary care, hospitals and specialist centres.

They provide national standards and targets with the aim of improving levels of care and removing unacceptable regional and local variations.

Locally, NSFs are implemented within the framework of the local delivery plan, with progress monitored by the Healthcare Commission.

Seven NSFs have been published:

NSFs and the hospital service

Much of the work involved in implementing national service frameworks falls on the hospital staff in the relevant specialties.

Well-run clinical directorates will already be on top of many of the NSF requirements.

The work remaining to be done often involves the better coordination of the whole treatment process and improved co-operation between hospital staff and those in primary care and other agencies.

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National service framework for mental health

The NSF sets national standards and defines service models in the five areas:

Elements of the NSF are included in local delivery plans and clinical governance arrangements.

Implementation is backed by targeted funding which, for instance, is leading to the greater use of modern drug therapies.

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The national cancer plan

The plan brings together all aspects of cancer care, including research, prevention, screening, diagnosis and treatment.

Three commitments underpin the plan:

There are a number of targets involving waiting times for diagnosis and treatment.

Various initiatives have been funded to help meet the objectives of the plan, including smoking cessation services in primary care.

Targets are also included for improved screening.

The cancer services collaborative supports the ongoing implementation of the cancer plan. The first phase of the collaborative comprised nine cancer networks, each of which received £500,000 to run up to five tumour-specific projects to improve services for patients with bowel, breast, lung, ovarian and prostate cancer over a period of 18 months.

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National service framework for coronary heart disease

The national service framework covers the prevention, diagnosis and treatment of CHD, and sets out standards and service models.

There are 12 standards which cover:

Some 80–90 per cent of people discharged from hospital following a heart attack should be prescribed aspirin, beta-blockers or statins.

The NHS Plan target of 6,000 extra heart operations by April 2003 was exceeded.

Specialist smoking cessation clinics and rapid-access chest pain clinics have been set up in many locations.

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National service framework for older people

The national service framework (NSF) for older people advocates national standards of healthcare for all older people.

It is having a fundamental influence on the hospital service as the majority of patients treated in hospitals fall into the older category.

The NSF aims to improve treatment standards of care and treatment and ensure all resources are fairly distributed, irrespective of the age of the recipient.

It highlights:

Rehabilitation services are being improved. Older people should have access to a new range of intermediate care services at home or in designated care settings.

Services are being developed to enable more older people to continue to live independently at home.

Healthy lifestyles are being more actively promoted and prevention of health problems is being emphasised, for example, by immunisation against influenza.

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National service framework for diabetes

The NSF aims to:

The standards cover:

The delivery strategy, published in January 2003, calls for PCTs to set up diabetes networks, review local baseline assessments, ensure systematic treatment regimes, participate in audits and develop training programmes.

By 2006, a minimum of 80 per cent of people with diabetes are to be offered screening for the early detection of retinopathy, and practice-based registers should be updated.

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National service framework for children

The national service framework for children, young people and maternity services establishes standards for promoting the health and wellbeing of children, young people and mothers; and for providing high quality services which meet their needs.

There are 11 standards covering the following areas:

The 10-year programme is intended to stimulate long-term and sustained improvement in children’s health. The NSF aims to ensure fair, high quality and integrated health and social care from pregnancy, right through to adulthood.

The NSF must be implemented by NHS trusts, primary care trusts and local authorities over the next ten years although the timing and planning of implementation are local matters.

The NSF standards will be delivered locally and monitored by independent bodies including the Healthcare Commission, the Commission for Social Care Inspection and OFSTED.

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Renal services NSF

The renal services NSF was delivered in two parts:

PCTs will be responsible for delivering renal services and establishing need. The Healthcare Commission will inspect against these quality markers indicated in this NSF.

Part one has five standards:

  1. Patients are to have access to information that enables them with their carers to make informed decisions and encourages partnership in decision-making, with an agreed care plan that supports them in managing their condition
  2. Patients approaching established renal failure should receive timely preparation for renal replacement therapy so the complications and progression of their disease are minimised, and their choice of treatment options is maximised
  3. Patients with established renal failure should surgery for permanent vascular or peritoneal dialysis access, which is monitored and maintained to achieve its maximum longevity
  4. Renal services should deliver high quality clinically appropriate forms of dialysis designed around individual needs and preferences and are available to patients of all ages throughout their lives
  5. Patients likely to benefit from a kidney transplant should receive a high quality service which supports them in managing their transplant and enables them to achieve the best possible quality of life

Part 2 consists of four quality requirements:

  1. People at increased risk of developing or having undiagnosed chronic kidney disease, especially people with diabetes or hypertension, are assessed and their condition managed to preserve their kidney function
  2. People with a diagnosis of chronic kidney disease receive timely, appropriate and effective investigation, treatment and follow-up to reduce the risk of progression and complications
  3. People at risk of, or suffering from, acute renal failure are identified promptly, with hospital services delivering high quality, clinically appropriate care in partnership with specialised renal teams
  4. People with established renal failure receive timely evaluation of their prognosis, information about the choices available to them, and for those near the end of life a jointly agreed palliative care plan, built around their individual needs and preferences

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The national service framework for long term conditions

Long term neurological conditions such as Parkinson's disease, motor neurone disease, epilepsy, multiple sclerosis and acquired brain and spinal cord injuries are covered by the long term conditions NSF.

The targets were implemented in April 2005, and should be achieved by 2015.

The NSF's quality requirements are:

  1. People with long-term neurological conditions should be offered integrated assessment and planning of their health and social care needs. They are to have the information they need to make informed decisions about their care and treatment and support in managing their condition themselves.
  2. People suspected of having a neurological condition are to have prompt access to specialist neurological expertise for an accurate diagnosis and treatment as close to home as possible.
  3. People needing hospital admission for a neurosurgical or neurological emergency should be assessed and treated in a timely manner by teams with the appropriate neurological and resuscitation skills and facilities.
  4. People with long-term neurological conditions who would benefit from rehabilitation are to receive timely, ongoing, high-quality services in hospital or other specialist settings to meet their needs. When ready, they should get the help they need to go home for ongoing rehabilitation and support.
  5. People with long-term neurological conditions living at home should have ongoing access to a range of rehabilitation, advice and support to meet their continuing and changing needs, increase their independence and autonomy and help them to live as they wish.
  6. People with long-term neurological conditions should have access to appropriate vocational assessment, rehabilitation and ongoing support, so they can find, regain or remain in work and access other occupational and educational opportunities.
  7. People with long-term neurological conditions should get timely, appropriate equipment and adaptations to accommodation to support them in living independently, help them with their care, maintain their health, and improve their quality of life.
  8. Health and social care services must work together to provide care and support so people with long-term neurological conditions can achieve maximum choice about living independently at home.
  9. People in the later stages of long-term neurological conditions should get a comprehensive range of palliative care services when they need them to control symptoms, offer pain relief, and meet their needs for personal, social, psychological and spiritual support, in line with the principles of palliative care.
  10. Carers of people with long-term neurological conditions should have access to appropriate support and services that recognise their needs both in their role as carer and in their own right.
  11. People with long-term neurological conditions should have their specific neurological needs met while receiving treatment or care for other reasons in any health or social care setting.

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