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National Service Frameworks are one of the “big ideas” in healthcare policy in England. They are designed to improve the quality of health care by setting standards of care including structures, processes, and intended outcomes for key conditions or client groups. These frameworks seek to level up to the good, and to eliminate unacceptable practice.
The prototype for these frameworks was the development of a National Plan for Cancer Care. National Service Frameworks were then developed for Mental Health and Coronary Heart Disease. For all three subjects there were concerns that the NHS was falling behind international standards.
The Older People’s National Service Framework was next to be announced; it was different from its predecessors because it covered a population group rather than a set of conditions. It was larger and more complex, as older people consume about 50% of expenditure in health and social care; and it was the first framework to set standards for social as well as health care.
A framework for older people was needed because of widespread concerns about the loss of dignity suffered by older people, in hospital settings in particular. A campaign was mounted by a national newspaper (the Observer) and an older people’s charity (Help the Aged), which highlighted anecdotal concerns.
The Secretary of State for Health commissioned an investigation by the Health Advisory Service, which conformed widespread problems.1
The Secretary of State then announced that there was to be a framework for older people, which would set standards, …