Regulations for service providers and managers

These services are complex and vary greatly. Generally, however, they provide medical and/or surgical investigations, diagnosis and treatment for physical illness or condition, injury or disease.

They can provide services to adults, children or both. They may provide services to a broad range of people or to a particular group of people.

They can:

• Admit people on a day case basis or as inpatients.
• Admit people at short notice or in an emergency (whether or not they have a dedicated emergency department).
• See people on an outpatient basis.

They may also provide services such as:

• Surgical operations
• Specialist medical treatments
• Accident and emergency
• Consultations
• Diagnostics
• Maternity and neonatal
• Pathology
• Termination of pregnancy
• Complex dental procedures
• Liaison psychiatry.

People are usually admitted to the service under the care of a medical or clinical practitioner. The service may also employ a broad range of healthcare professionals to meet the needs of the people using the service.

Some services may be smaller than others and may not provide the same range of acute services depending on the size of the hospital (for example, an accident and emergency department).

Examples of services that fit under this category:

• NHS acute hospitals
• Independent acute hospitals
• Termination of pregnancy clinics
• NHS community hospitals
• Independent sector treatment centres (ISTCs)
• Community hospitals
• Cosmetic surgery clinics
• Specialist or single specialty hospitals
• Maternity hospitals.
• IVF clinics providing surgical treatment or endoscopy
• Haemodialysis units
• Minor injuries units.

These services involve the administration of oxygen (whether or not combined with one or more other gases) to a person in a sealed chamber that is gradually pressurised with compressed air. The services are carried out by, or under the supervision of, a medical practitioner.
The services help to treat a range of medical conditions including:

• Air or gas embolism
• Decompression illness
• Carbon monoxide poisoning
• Gas gangrene
• Necrotising fasciitis
• Other conditions approved by the Undersea and Hyperbaric Medical Society.

Examples of services that fit under this category:

• Type 1 hyperbaric chambers
• Type 2 hyperbaric chambers.

These provide a range of services for conditions where curative treatment is no longer an option, and people are approaching the end of their life. They provide care, treatment and support for people and their families and carers, including respite care for people who live with friends or family at home.

Care, treatment and support can be provided in accommodation or in the community. It can be long or short-term care, on an inpatient basis or provided through day care, day therapy or outreach services.

The services will generally employ or work with a broad range of health and social care professionals to meet the needs of people using the service.

Examples of services that fit under this category:

• Adult hospices
• Children's hospices
• Day hospices
• End of life care teams
• Hospice at home.

These services provide a range of highly specialised care, treatment and support to people with physical or neurological illnesses, cognitive impairments or injuries that are unlikely to improve. These conditions may have been inherited or acquired, and may not necessarily be life-limiting. This care, treatment and support is the sole or main purpose of the service.

People may be cared for by these services for many years at a time, and will be 'admitted' and stay at the facility over time. People using these services require the support of medical practitioners and a range of other healthcare professionals, and their care, treatment and support may involve highly technical interventions such as ventilation.

These services are for people with mental health needs, a learning disability or problems with substance misuse who are admitted to hospital, involving an overnight stay, for assessment or treatment when there is a need for more intensive support than would typically be provided in the community, or a need for a specialist assessment or intervention.

This is usually because of:

• An acute episode of a severity that requires 24-hour care.
• A need for a higher level of security.
• A need for a specialist assessment, treatment and/or rehabilitation.

This might include providing care, treatment and support for people detained under the Mental Health Act 1983.

Some people with mental health needs or a learning disability may require longer-term accommodation in hospital, while others may be admitted for short periods or treated on a day case basis.

These services also cover inpatient treatment for people who have problems with substance misuse. They usually involve short periods of hospital-based treatment, including 24-hour medical cover to assess and stabilise the person, and treatment for withdrawal from drugs (legal, illegal and substitute preparations) or detoxification from alcohol.

All the hospital services above will usually comprise one or more wards in which care, treatment and support is provided. There may be a range of other facilities including occupational and arts therapies, psychological therapies, psychosocial interventions, recreational activities and services to address physical health needs.

Examples of services that fit under this category:

• NHS or independent services that provide specialist hospital services for people with mental health needs, people with a learning disability and people who have problems with substance misuse.
• Child and adolescent mental health services (CAMHS) tier 4.

This covers all health services provided in prisons, young offender institutions (YOIs) and immigration removal centres (IRCs). Some providers may be permanently based in the prison, YOIs or IRCs; others may be based elsewhere but provide outpatient clinical sessions within the prison.

Prison healthcare services can include a broad range of healthcare, for example general practice, dentistry, mental health, substance misuse, acute and end of life care. We would usually expect providers of prison healthcare services to cover one or more additional service types, depending on the type of service they are providing. They employ a broad range of health and social care professionals to meet the needs of people who use their services.

Examples of services that fit under this category:

• Mental health in-reach teams
• Counselling, assessment, referral, advice and through-care (CARAT) teams
• Prison drug rehabilitation programmes
• Young offenders institutions
• Some immigration removal centres.

These services provide, as their sole or main purpose, treatment to people following an illness or injury that impairs their physical, mental or cognitive wellbeing, but for which continued rehabilitative care is likely to bring about improvement.

They may consist of a range of services that promote faster recovery from illness, prevent unnecessary admission to acute services, support timely discharge and maximise independent living.

The services can be provided on a short or long-term basis, in hospital, residential, day care or domiciliary settings. They are mainly provided within healthcare settings but can also be provided in a social care setting.

Examples of services that fit under this category:

• Intermediate care schemes
• Rehabilitation units.

These services are provided to adults and young people who have problems with misusing drugs and/or alcohol. They provide care, treatment and support, both pharmacological and psychosocial, and help people to reintegrate into their communities, focusing on the coping strategies and life skills they need to do this.

They often employ a broad range of health and social care professionals to meet the needs of people who use their services.

Some of these services may also provide assessment, stabilisation and treatment for withdrawal from drugs (legal, illegal and substitute preparations) or detoxification from alcohol.

Examples of services that fit under this category:

• Residential substance misuse rehabilitation services
• Crisis and stabilisation intervention units.

These services supply a range of healthcare staff other than doctors, for example, nurses or allied health professionals, to people who need healthcare support in their own home, in community settings or in child development units.

The care provided may be short or long term, and meet acute or chronic healthcare needs. The services may help people to live independently in the community and they are directly responsible for the quality of the care and support provided by the staff they supply, and do not include employment agencies.

Examples of services that fit under this category:

• District nursing
• Nurses agency
• Community physiotherapy team
• Health visiting team
• Support worker team
• Children's community nurses
• Community paediatric therapies
• Community midwifery
• School nursing
• Family planning and sexual health clinics
• Community rehabilitation teams.

These services involve doctors working in premises, or a room, designated for medical consultation. Often the doctor will complete medical consultations, including physical examination and simple physiological measurement (such as blood pressure tests). They will discuss diagnosis and treatment options and may prescribe medicines for the person to take at home.

There may be other healthcare professionals, for example nurses, supporting the work of the doctor.

Examples of services that fit under this category:

• Independent doctors consulting rooms
• NHS GP practices
• Slimming clinics.

These services involve doctors working in premises, or a room, designated for minor medical treatments as well as medical consultation. Often the doctor will complete medical consultations, including physical examination and simple physiological measurement (such as blood pressure tests). They will discuss diagnosis and treatment options and may prescribe medicines for the person to take at home.

They may also undertake minor invasive investigations or procedures, such as conscious endoscopy, in a treatment room designed for this purpose.
There may be other healthcare professionals, for example practice nurses, supporting the work of the doctor.

Examples of services that fit under this category:

• Independent doctors consulting rooms
• NHS GP practice
• Early medical abortion clinics
• Travel vaccination services
• Polyclinics.

These services involve registered dentists and dental care professionals usually working in premises designed for consultation and treatments, but they can also be provided in a person's place of residence. Consultations and examinations will involve discussion of the treatment options with the patient and may include dental radiography. Treatment is usually provided in a dedicated room and, in consultation with the patient, may be under local anaesthetic or use a laser. Medicines may be prescribed as part of the treatment.

Examples of services that fit under this category:

• Primary care dental services (dentists on the high street, NHS funded, private or both)
• Dental out-of-hours services.

These services provide individual health assessment and/or screening to people, using:

• Diagnostic imaging, such as:
  • X-rays
  • Computed tomography (CT)
  • Magnetic resonance imaging (MRI)
  • Ultrasound scanning
  • Gamma cameras
  • PET scanners
• Pathology
• Physiological measurement
• Genetic screening services
• Endoscopy.

They provide, as the sole or main purpose, diagnosis or screening. They do not usually provide any other health or social care services. While large acute hospitals will have similar services, this category relates only to these dedicated, focused services.

These services undertake investigations on behalf of the person using the service or on behalf of a healthcare professional that the person is consulting (who is legally permitted to request such investigations).

They will involve a range of healthcare professionals that may include:

• Medical practitioners
• Nurses
• Radiographers
• Physiological measurement technicians.

Examples of services that fit under this category:

• Health screening centres
• MRI or CT scanning services (fixed and mobile)
• Baby scanning services
• Endoscopy centres and clinics
• Stand alone or mobile urodynamic services.

These services provide care, treatment and support in the community for people with a learning disability, through a wide range of service models.

They employ a broad range of health and social care professionals mainly in multi-disciplinary teams.

They help people to live as independently as possible, manage their condition and improve it where this is possible. People using these services may receive support over a long period or for short-term interventions. They may move between the various community teams to ensure that their changing needs are met.

Examples of services that fit under this category:

• Community learning disability teams
• Challenging behaviour/outreach teams.

These services involve doctors visiting people in premises where the person using the service is living (on a long or short-term basis). They may also provide services through an internet website or over the phone where the initial consultation is with either non-clinical staff or with a nurse or a doctor.

The doctors provide medical consultations, including physical examination and simple physiological measurement (such as blood pressure tests). They will discuss diagnosis and treatment options and may prescribe medicines for the person to take at home.

There may be other healthcare professionals, for example nurses, supporting the work of the doctor.

Examples of services that fit under this category:

• Independent medical agencies
• GP out-of-hours services
• Community doctors

These services provide care, treatment and support in the community for people with mental health needs, through a wide range of service models.

They employ a broad range of health and social care professionals mainly in multi-disciplinary teams.

They help people to recover by providing a broad range of interventions reflecting the psychological, social and physical needs of the individual.

People using these services may receive support over a long period or for short-term interventions. They may move between the various community teams to ensure that their changing needs are met, or be in contact with them simultaneously.

This may include providing care, treatment and support to people subject to supervised community treatment under the Mental Health Act 1983 (amended in 2007).

Examples of services that fit under this category:

• Child and adolescent mental health services (CAMHS) (tiers 2, 3 and 4)
• Community-based services that provide assessment and treatment for people with mental health needs including:
  • community mental health teams
  • assertive outreach
  • early intervention teams
  • court diversity teams
  • crisis resolution home treatment teams.

These services are provided in the community for people who misuse drugs and/or alcohol. They provide care, treatment and support, both pharmacological and psychosocial, and help with social and other needs so that people can reintegrate into their communities. They employ a broad range of health and social care professionals to meet the needs of people who use their services.

Examples of services that fit under this category:

• Community drug and alcohol teams
• Prescribing services.

These services are provided in parallel with an accident and emergency department and vary greatly from one service to another. They generally comprise a triage service, run by doctors and nurses.

They will not usually screen people whose symptoms require immediate, very urgent or emergency care. Instead, they screen standard cases where time is not of the essence, and where possible, refer these for immediate consultation with an on-site primary care provider.

They may provide services such as:

• Consultations with a doctor
• Physical examinations and simple physiological testing and measurement
• Diagnosis and treatment
• Prescribing medicines
• Referrals to other primary care services.

Examples of services that fit under this category:

• Minor injury units
• Urgent care centres
• Walk-in centres.

A care home is a place where personal care and accommodation are provided together. People may live in the service for short or long periods. For many people, it is their sole place of residence and so it becomes their home, although they do not legally own or rent it. Both the care that people receive and the premises are regulated.

In addition, qualified nursing care is provided, to ensure that the full needs of the person using the service are met.

Examples of services that fit under this category:

• Nursing home
• Convalescent home with nursing
• Respite care with nursing
• Mental health crisis house with nursing.

A care home is a place where personal care and accommodation are provided together. People may live in the service for short or long periods. For many people, it is their sole place of residence and so it becomes their home, although they do not legally own or rent it. Both the care that people receive and the premises are regulated.

Examples of services that fit under this category:

• Residential home
• Rest home
• Convalescent home
• Respite care
• Mental health crisis house
• Therapeutic communities.

These services provide education, care, and training in independence for young people with a learning disability and/or physical disability. The colleges are first and foremost educational establishments and are regulated by Ofsted. The Care Quality Commission regulates the personal care and accommodation that a college provides where 10% or more of the students require personal care.

These services provide personal care for people living in their own homes. The needs of people using the services may vary greatly, but packages of care are designed to meet individual circumstances.

The person is visited at various times of the day or, in some cases, care is provided over a full 24-hour period. Where care is provided intermittently throughout the day, the person may live independently of any continuous support or care between the visits.

Examples of services that fit under this category:

• Domiciliary care agency.

These services cover many different arrangements. Usually, they consist of purpose built accommodation in which varying amounts of care and support can be offered, and where some services and facilities are shared.

The care that people receive is regulated by the Care Quality Commission, but the accommodation is not.

Shared Lives is care and/or support provided by individuals, couples and families who have been approved and trained for that role by the service registered with Care Quality Commission. Care and/or support may also be provided either within or outside of the home of the carer as well as kinship support to people living in their own homes. It is the service that is regulated not the individual accommodation that is owned or rented by private residents.

These services involve a person living in their own home and receiving care and/or support in order to promote their independence. The care they receive is regulated by the Care Quality Commission, but the accommodation is not. The support that people receive is continuous, but is tailored to their individual needs. It aims to enable the person to be as autonomous and independent as possible, and usually involves social support rather than medical care.

These services respond to emergency 999 calls, providing medical care in emergency and non-emergency settings outside of hospital. This includes the provision of emergency response and transport services for people with serious or life-threatening conditions.

Ambulance services also provide a range of other urgent and planned healthcare and patient transport services. They may provide care, treatment and support and employ a range of healthcare professionals to meet the needs of the people who use the service.

Examples of services that fit under this category:

• Advice, treatment and/or transport of people in emergency situations or with urgent health needs
• Air ambulance service
• Patient transport services.

These involve the management of the supply of blood, blood-derived products and biologically derived tissues to a healthcare provider for the purposes of administering, grafting or transplantation into a human being.

Examples of services that fit under this category:

• NHS Blood and Transplant.

These services provide, as their sole or main purpose, a range of clinical services to people from a distance in an urgent or emergency situation. The initial consultation is usually with a non-clinical call handler who may triage to a clinician. They may provide care, treatment and support to people using:

• Telephone systems
• Digital systems
• Email.

The services may include:

• Simple clinical advice and reassurance
• Diagnosis
• Health screening
• Prescription of medicines
• Referral to another clinical service.

Examples of services that fit under this category:

• NHS 111.