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Core services: NHS trusts

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  • Organisations we regulate

Core services are the ones that most trusts provide. They are typically services that people use the most, or in some cases, the ones that may carry the greatest risk.

We will not always inspect every ward or part of a core service in a single inspection. To help us select and prioritise the specific areas to visit, we may either:

  • select a random sample of some wards or parts of the service
  • select others according to various factors about risk, quality and the context of the services.

You can find out more about each of the core services by clicking the name below.

Acute core services

We inspect eight core services in acute hospitals.

Urgent and emergency services

Urgent and emergency care refers to the service that people can access, without a referral, in an urgent or emergency situation.

Its purpose is to treat patients presenting as an emergency or with urgent medical needs. Services include emergency departments, also called accident and emergency or A&E departments, and urgent care centres (UCCs). They may also include a clinical decision unit, ambulatory care unit, minor injury unit or walk-in centre. If the trust provides an urgent care centre we will also include this in the core service inspection.

A UCC may be located on one provider’s premises but another provider may be responsible for it. In these cases the responsible provider must function effectively with the emergency department. We will look at the care pathways between the two providers during the inspection.

Please note: in CQC’s inspections, the treatment of children in the emergency department is part of the urgent and emergency core service. We do not consider it as part of the trust’s services for children and young people.

Medical care (including older people’s care)

This includes the broad range of specialties not included in the other core services. In general terms, medical care includes those services that involve assessment, diagnosis and treatment of adults by medical interventions rather than surgery. Medical care also includes endoscopy services. Areas that we will inspect include:

  • acute assessment units (also known as medical assessment units)
  • general wards
  • specialty wards, including gerontology (also known as care of the elderly) wards.

Surgery

This core service involves most surgical activity in the hospital. It includes planned (elective) surgery, day case surgery and emergency surgery. We inspect pre-assessment areas, theatres and anaesthetic rooms and recovery areas.

Surgical disciplines could include:

  • trauma and orthopaedics (T&O)
  • colorectal surgery
  • general surgery
  • urology
  • ear, nose and throat ( ENT)
  • cardiac surgery
  • vascular surgery
  • ophthalmic surgery
  • neurosurgery
  • breast surgery
  • upper gastro-intestinal surgery
  • plastics and maxillofacial surgery
  • thoracic surgery.

The surgery core service also includes interventional radiology.

We include some specialist surgery, including caesarean section, under the maternity core service.

Critical care

This includes areas where patients receive more intensive monitoring and treatment for life-threatening conditions. These areas are usually described as high dependency units (level 2), intensive care units (level 3) or by the umbrella term, critical care units. Critical care should also include outreach services provided in other areas of a hospital.

The Department of Health has defined levels of care (Comprehensive Critical Care, 2000). The critical care core service includes care at levels 2 and 3, including high dependency units. Some trusts provide units for specific conditions such as renal or respiratory failure and spinal injury. The units are included in this core service if they are funded as a high dependency unit and/or are led by a consultant intensivist.

Maternity

This includes all services for women that relate to pregnancy. It includes ante and post-natal services, as well as labour wards, birth centres or units and theatres providing obstetric related surgery.

A hospital can provide some of these services in the community setting, or they may be the responsibility of a different provider. We will look at the pathways between the two settings when we inspect.

If a new born baby requires treatment in a special care baby unit (SCBU) or neonatal unit where a paediatrician delivers the care, this comes under the core service for children and young people.

Services for children and young people

This includes all services for children up to the age of 18 and includes:

  • inpatient wards
  • outpatients
  • end of life care
  • all paediatric surgery
  • the interface with maternity and community services
  • paediatric intensive care units
  • arrangements for transition to adult services.

It does not include care provided in the emergency department, as this is covered under the urgent and emergency core service.

End of life care

End of life care involves all care for patients who are approaching the end of their life and following death. A trust may deliver care on any ward or as part of any of its services. It includes aspects of basic nursing care, specialist palliative care, bereavement support and mortuary services.

The definition of end of life includes patients who are ‘approaching the end of life’ when they are likely to die within the next 12 months. This includes patients whose death is imminent (expected within a few hours or days) and those with:

  • advanced, progressive, incurable conditions
  • general frailty and co-existing conditions that mean they are expected to die within 12 months
  • existing conditions that put them at risk of dying if there is a sudden acute crisis in that condition
  • life-threatening acute conditions caused by sudden catastrophic events.

We inspect end of life care that relates to stillbirths under the maternity core service. End of life care that relates to terminations of pregnancy and miscarriages are inspected under the gynaecology additional service.

Where a provider reports a very small number of deaths, we may report end of life care in the most relevant core service. This will usually be medicine or surgery and is likely to only affect specialist trusts.

We inspect end of life care services that relate to children and young people under the core service for children and young people.

Where a provider reports a very small number of deaths, we may decide to report end of life care in the most relevant core service. This will usually be medicine or surgery and is likely to only affect specialist trusts.

Outpatients

Outpatient services include all areas where people:

  • receive advice or care and treatment without being admitted as an inpatient or day case

It does not include children’s outpatient services, as these are covered under the children and young people service.

Acute specialist trusts

When we inspect acute specialist trusts we only select the core services that are appropriate for the services the trust offers. Inspections will often be smaller because of the specialist nature of services. We may also adapt a core service to make it more meaningful to providers and the public. For example, the generic maternity core service may not be appropriate for NHS trusts that specialise in treating women, as most of their activity would be captured under this one core service.

We will consider any additional services for specialist trusts individually.

We will always inspect the following two additional core services in a trust that specialises in treating children and young people:

Neonatal services

These provide extra care for new born babies who may be born prematurely or need treatment in hospital after birth. The settings depend on the type of treatment, such as neonatal intensive care units (NICU) and special care baby units (SCBU).

Transition services

Transition is the planned transfer of young people with long-term conditions and/or complex needs from child-centred to adult- health and social care services. When we inspect this core service we will look at how transition works across all the trust’s services, including how it works with other organisations.

Mental care in acute trusts

When we inspect acute trusts we will now closely scrutinise how they provide mental health care and support for patients with mental health needs across all the core services we inspect.

This includes people:

  • with diagnosable mental health conditions
  • with co-morbid conditions
  • who are inpatients for physical health reasons
  • who have or develop mental health needs.

The evidence we collect in relation to mental health care informs our judgement for each core service and at provider level, including the assessment of the well-led key question. Acute trusts don’t receive an individual rating for the mental health care they provide. However, we use the evidence to inform the ratings at core service level, for well-led and at overall provider level. We expect acute trusts to show evidence of how they are meeting the needs of patients with mental health conditions.

Ambulance core services

We inspect three ambulance core services.

Emergency operations centre

The emergency operations centre (EOC) receives and triages 999 calls from the public and other emergency services. It gives advice and dispatches an appropriate service to the scene.

It also receives and triages 999 calls relating to major incidents and dispatches the appropriate response as a Category 1 provider under the Civil Contingencies Act 2004 (Part 1). This can include hazardous area response teams.

When callers do not need an ambulance response the EOC provides assessment and treatment advice (‘hear and treat’).

The EOC also manages requests from healthcare professionals to transport people from the community into hospital or between hospitals.

Emergency and urgent care services

Emergency and urgent care services include when ambulance crews assess, treat and care for patients at the scene. The patient can either be transported to hospital (‘see and convey’) or discharged from the care of the service (‘see and treat’).

The core service includes transport by air when the provider runs the air ambulance itself, or where it supplies staff to another entity, such as an air ambulance charity.

This core service covers the provider’s planning and response to major incidents and emergencies as a Category 1 provider under the Civil Contingencies Act 2004 (Part 1). It takes into account special operations such as serious and protracted incidents.

It also includes being prepared for, and supporting, events and mass gatherings.

If the ambulance trust manages emergency response from other parties, these are also included in the core service. Examples include:

  • community first responder schemes involving the public
  • co-responder schemes with agencies such as fire and rescue or the armed forces.

High dependency and intensive care transport between hospitals or other care settings is also included, as well as other specialist transport that requires an emergency ambulance. This might be:

  • from hospital for end of life care at home
  • for patients with mental health conditions who need specialist care.

Patient transport services

These are non-urgent and non-specialist services. They transport patients between hospitals, home and other places such as care homes.

The ambulance core service includes the patient transport control room and dispatch operation and any assessment of a patient’s eligibility for the service.

This core service also includes any volunteer driver scheme where it is managed by the ambulance trust.

Other services (where relevant)

Some ambulance trusts also provide a 111 service, out-of-hours service or urgent care centre. CQC’s Primary Medical Services team will inspect these services and coordinate this with our Hospital inspection team where relevant.

For all services included under the ambulance core service, we will look at how the trust manages business continuity. This includes when it only affects the provider, such as loss of facilities, or as part of a wider event, such as severe weather.

Community health core services

We inspect four core services within community health.

Community health services for adults

These include health services for adults provided in their homes or in a community-based setting. They often focus on providing planned care, rehabilitation following illness or injury, ongoing and intensive management of long-term conditions, coordinating and managing care for people with multiple or complex needs, and health promotion.

The core service includes:

  • Community nursing services or integrated care teams, including district nursing, community matrons and specialist nursing services
  • Community therapy services such as occupational therapy and physiotherapy
  • Community intermediate care
  • Community rehabilitation or reablement services
  • Community outpatient and diagnostic services

The core service does not include:

  • Community end of life care for adults (inspected as part of the community end of life care core service)
  • Primary medical or dental care, urgent care services, community learning disability or mental health services (inspected as part of other additional services or relevant core services for other sectors). For example, mental health service inspections include the core service of community mental health services for people with a learning disability or autism.

Community health services for children, young people and families

This covers health services for babies, children, young people and their families in their homes, community clinics or schools. It includes universal health services and health promotion (such as health visiting and school nursing) and delivering and coordinating specialist or enhanced care and treatment including specialist nursing services, therapy services and community paediatric services.

These services provide and coordinate care and treatment for children and young people with long-term conditions, disabilities, multiple or complex needs and children and families in vulnerable circumstances.

This core service can also include community sexual health services for people of all ages and community dental services for people of all ages where they are not covered as an additional service.

The core service does not include:

  • Child and adolescent mental health services (included in the mental health CAMHS core service)
  • Community end of life care for children and young people (included in the community end of life care core service)
  • Community midwifery services (included in the acute maternity core service)
  • Social care for children and young people (regulated by Ofsted).

Community health inpatient services

This includes all inpatient and day case wards in community hospitals for people of all ages.

Examples of the care provided include:

  • Inpatient rehabilitation
  • Inpatient intermediate care
  • Inpatient nursing and medical care for people with long-term conditions, progressive or life-limiting conditions or for people who are old or frail
  • Minor surgical procedures.

This core service does not include:

  • Other community health services that the provider runs from a community hospital site, such as community nursing or therapy clinics or outpatient services (included in community health services for adults and/or for children, young people and families core services)
  • End of life care provided to people on community inpatient wards (covered by the community end of life care core service)
  • Any services that are run from the location but provided by other providers, such as walk-in centres.

Community end of life care

This includes all end of life care for adults, young people and children that is provided in people’s homes and in community hospitals, whether provided by specialist palliative care or hospice at home teams or as part of other services such as district or community nursing. This core service also includes services in a hospice setting where they are run by a provider with a range of community health services.

Where a provider reports a very small number of deaths, we may decide to report end of life care under the most relevant core service, usually community health services for adults.

We will consider additional services individually.

Mental health core services

We inspect 11 core services in mental health.

Mental health wards

Acute wards for adults of working age and psychiatric intensive care units

Acute wards provide care and treatment for people who are acutely unwell and whose mental health problems cannot be treated and supported safely or effectively at home. This core service does not include wards where people stay for longer periods (for example, long stay or rehabilitation wards).

Psychiatric intensive care units (PICUs) provide high intensity care and treatment for people whose illness means they cannot be safely or easily managed on an acute ward. People normally stay in a PICU for a short period before they can transfer to an acute ward once their risk has reduced.

Long stay or rehabilitation mental health wards for working age adults

These wards provide care and treatment for people whose needs are more complex, which require them to stay in hospital for longer. People may be referred here after a period on an acute ward when they have not recovered enough to be discharged home. Rehabilitation wards may also provide step-down for people who are moving on from secure mental health services.

Forensic inpatient or secure wards

These wards provide care and treatment in hospital for people with mental health problems who pose, or who have posed, risks to other people. People in secure services have often been in contact with the criminal justice system. These services may be low, medium or high secure, reflecting the different levels of risk that people may present.

Note: we will inspect high secure hospitals separately as an additional service.

Child and adolescent mental health wards

Child and adolescent mental health services (CAMHS) may assess and treat children and young people as an inpatient in hospital. This may be when community-based services cannot meet their needs safely and effectively because of their level of risk and/or complexity and where they need 24-hour nursing and medical care.

Wards for older people with mental health problems

These services provide assessment, care and treatment for people whose mental health problems are often related to ageing. This may include a combination of psychological, cognitive, functional, behavioural, physical and social problems.

Wards for people with a learning disability or autism

These are specialist inpatient services for adults with a learning disability and/or autism who need assessment and treatment for mental health conditions.

There are different models of services, but all patients in these wards should have their mental and physical healthcare needs assessed and receive care and treatment in line with their care plan. In all cases, the clear goal is to support people to return to the community and a good quality of life. This involves locally provided treatment in the least restrictive setting.

Please also refer to our guidance on registering these services.[link]

Community-based mental health and crisis response services

Community-based mental health services for adults of working age

These services provide care and treatment for people who need a greater level of mental health care than primary care services can provide. There is a wide range of service models and different types of interventions. People using these services may receive support over a long period or for short-term interventions.

Mental health crisis services and health-based places of safety

Community-based mental health crisis services provide care and treatment for people who are acutely unwell to avoid having to admit them to hospital. These services include crisis resolution and home treatment teams that see people in their homes and crisis houses for people who cannot be treated at home but who do not need to be admitted to hospital.

A health-based place of safety is a room, or suite of rooms, where people are assessed when they have been detained by the police under section 135 or 136 of the Mental Health Act. People will usually stay in a place of safety for a very short period, normally no longer than 24 hours.

Specialist community mental health services for children and young people

Specialist community child and adolescent mental health services (CAMHS) provide assessment, advice and treatment for children and young people with severe and complex mental health problems. They also provide support and advice to their families or carers.

Services are usually multi-disciplinary teams of mental health professionals providing a range of interventions in the community, working with schools, social care, charities, voluntary and community groups.

Community-based mental health services for older people

These services provide assessment, care and treatment to older people with mental health problems that are often related to ageing. People may receive services in their own home or in a care home.

Community mental health services for people with a learning disability or autism

These specialist services are usually provided by local community learning disabilities teams.

There are different types of service models, but the teams normally include staff from a range of health professions, such as psychiatrists, clinical psychologists, speech and language therapists and nurses (learning disabilities and sometimes mental health). Many teams include social care professionals, such as social workers.

These multi-disciplinary teams are providing more out-of-hours crisis services to support people with behaviour that challenges.

 

Last updated:
18 July 2018

 


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