Additional services: NHS trusts

An additional service is a service that we do not inspect routinely for all providers as a core service.

Additional services in an individual provider

We may choose to inspect an additional service for an individual provider because:

• it represents a significant proportion of the provider’s range of services
• we have identified it as potentially being rated outstanding
• we have identified it as being high risk.

When we select an additional service to inspect in an individual provider, we will normally inspect, report and rate it in the same way as the core services. There are some additional services where we would not aggregate ratings or apply the maximum intervals for re-inspections because it would be disproportionate to do so. For example in a non-specialist trust, we would not usually aggregate ratings for diagnostic imaging or gynaecology.

Examples of additional services that we may inspect in an individual provider include:

Acute

• gynaecology (including termination of pregnancy)
• diagnostic imaging
• rehabilitation
• spinal injuries

Mental health

• substance misuse services
• specialist mental health eating disorder services
• personality disorder services
• perinatal mental health services
• specialised mental health services for people who are deaf
• specialist mental health services for people with acquired brain injury
• gender identity services

We will also inspect mental health high secure hospitals as a separate additional service (and not as part of the mental health forensic core service). We will always apply the aggregation rules to a mental health high secure hospital rating. Therefore this may affect the overall trust level ratings.

Community health

• community dentistry
• sexual health services
• urgent care

For specialist acute trusts we may adapt core services from other types of provider where they better reflect the trust’s portfolio. For example, in a specialist women’s trust we may inspect the following as a separate additional service:

• termination of pregnancy (this is inspected as a core service in independent healthcare)
• neonatal services (this is a core service for children’s specialist trusts)

Additional services across providers

We may also select additional services to inspect across a range of providers or sectors. This will give us a broader view of the quality of services. We will inspect these services either within or across different sectors, or among a sample of providers.

When we inspect an additional service across a range of providers or sectors we will give a rating and publish a report for each service where appropriate. However, we will not normally apply our aggregation principles to these ratings and they will not affect overall trust-level ratings. This is because they will not be subject to the ‘frequency of inspection’ principles. If we included these ratings in our overall trust-level ratings, our overall ratings may become out of date. But we will take enforcement action where we need to.