Introduction

This Care Standards Update will outline the Consultation Document issued by the Department of Health on Independent Health Care.

Extent of the Consultation Document

The consultation document contains the draft Private and Voluntary Health Care Regulations, the draft Director of Private and Voluntary Health Care Regulations, draft national minimum standards for independent health care and a partial Regulatory Impact Assessment (RIA).

Scope of Regulation

For the purposes of the NCSC's regulatory remit, independent health care includes the following;

Independent Hospitals

• Acute hospitals (including day surgery hospitals);
• Establishments where the main purpose is treatment for psychiatric illness or mental disorder;
• Hospices (i.e. establishments the main purpose of which is to provide palliative care);
• Establishments where termination of pregnancy takes place (i.e. abortion clinics and hospitals);
• Establishments where obstetric services and medical services in connection with childbirth take place (i.e. maternity clinics and hospitals);
• Establishments were certain treatment using prescribed techniques and technologies take place.

Independent Clinics

• Private walk in medical centres;
• Exclusively private medical practitioners

Independent Medical Agencies

• Private call out medical practitioners

Commonality with Care Homes

Separate sets of regulations and standards are being produced for independent health care establishments and for care homes, in order to reflect the different natures of the types of services provided.

Under the current regulatory system some establishments are registered both as a residential care home and a nursing home. There will be no such dual registration arrangements under the new system. An establishment will be registered as either an independent hospital, an independent clinic or as a care home, and the relevant standards for the particular type of establishment will apply. Where services provided within a building or site satisfy more than one of these definitions the distinct services will be regarded as separate 'establishments' within the building or site and registered separately as such.

Structure and Approach

The intention is that there is a set of draft core standards which will apply to all independent health care providers regulated by the NCSC. They are supplemented by draft service - specific standards that will apply to the relevant individual areas of health care services to be regulated. The draft Private and Voluntary Health Care Regulations follow this core and service specific format.

Each standard is preceded by a statement of the intended outcome for patients to be achieved by the independent health care provider. The standards themselves are numbered and the full set of numbered paragraphs must be met in order to achieve compliance with the standard.

In order to help to distinguish and identify the standards in the consultation exercise, prefixes have been added to them, as follows:

Thus, it will be necessary for all providers of independent health care to satisfy the Core Standards together with the specific standards for their relevant area of health care, i.e. for hospice care all standards with the prefix "C" together with all standards with the prefix "H".
Core Standards

The Core Standards for independent health care deal with the following areas:

Acute Hospitals - Standards A1 - A44

These standards apply to:

• Establishments where one or more overnight beds are provided and the main purpose of which is to provide medical treatment for illness (subject to certain exceptions). This includes private hospitals that provide services for NHS patients.
• Other establishments the main purpose of which is to provide medical treatment under anaesthesia and sedation. This includes day hospitals where cosmetic surgery takes place.

Mental Health Establishments - Standards M1 - M46

The standards for mental health establishments apply to those non NHS establishments which, for the purposes of section 2 (3) of the Care Standards Act 2000, come under the definition of 'independent hospital' because either:

• The main purpose of the establishment is to provide medical or psychiatric treatment for mental disorder; and / or;
• Treatment or nursing (or both) are provided in the establishment for persons liable to be detained under the mental Health Act 1983.

The standards fall into two categories:

• They begin with those that apply to all mental health establishments (including for children and adolescents) that come within the definition of 'independent hospital' (as set out above);
• They end with those that, in addition, apply to mental health establishments that can take people liable to be detained (including for children and adolescents).

These standards do not apply to care homes, nor to establishments that mainly provide counselling or to psychiatrists' consulting rooms.

Hospices - Standards H1 - H16

Section 2(3) (a) (i) of the Care Standards Act brings within the definition of 'independent hospital' establishments the main purpose of which is to provide palliative care. For ease of reference, such establishments are described in the standards as hospices.

Maternity Hospital - Standards MC1 - MC8

Section 2(7) of the Care standards Act brings within the definition of 'independent hospitals' establishments in which obstetric services and / or, in connection with childbirth, medical services are provided. For ease of reference, such establishments are described in the standards as maternity hospitals.

Termination of Pregnancy Establishments - Standards TP1 - TP4

The standards apply to establishments in which terminations of pregnancy take place (defined as 'independent hospitals' under Section 2(7) (d) of the Care Standards Act).

Prescribed Techniques and Technologies - Standards P1 - P16

It is proposed that the NCSC will regulate not only the techniques and technologies currently regulated, but that regulation will be extended to include treatment using intense light sources and to hyperbaric oxygen treatment / therapy.

Private Doctors - Standards PD1 - PD12

These standards cover a variety of services that are provided by private medical practitioners. They apply to:

• Private walk in medical centres, where services are provided by a medical practitioner;
• Exclusively private medical practitioners (i.e. those who do no NHS work at all); and
• Agencies that provide doctors to private patients, for example in the patients own home, hotel or workplace.

Appendices

The appendices include:

• Categories and numbers of independent health care providers
• Details of the consultation group
• Glossary of terms
• Policies and procedure requirements
• Draft Regulations