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The National Care Standards Commission will regulate standards of domiciliary care for the first time. This article looks at the provisions of the Care Standards Act relating to domiciliary care and considers some of the issues which will arise when developing national minimum standards. It also looks at other care services regulated by the NCSC and other bodies established by the Care Standards Act.

Concerns about quality and standards of care in the nursing and residential home sector have exercised policymakers, managers and practitioners in both Australia and the UK for some years. While Australia is a relatively young country, demographically speaking, it has in place a coherent ‘aged care’ policy. The UK on the other hand, with its rapidly ageing profile, has only recently made a serious policy commitment to the health and social care agenda for older people. Australia therefore has several years of experience to be shared with the UK when it comes to policy and practice of quality improvement. In particular, there are valuable lessons to be learnt from Australia's national outcome standards and monitoring system for care homes, and its more recent introduction of a care homes accreditation system. Apart from identifying any issues associated with the implementation of such approaches to quality improvement, it is important to establish whether they have an impact on the quality of care and life of older residents. As the UK moves to implementing national minimum standards in 2002, lessons from Australia are timely and may help inform best practice and policy in long‐term care in the future.

Explores the theoretical context of quality and quality assurance in health care through a detailed review of the current literature. Outlines the definitions of quality and quality assurance. Identifies the two structural elements of quality assurance: quality assessment and quality improvement and control. Explores in some detail the elements of health care which are capable of assessment and the relationships between them. Finally, considers the mechanisms which can be used to improve health care if deficiencies are highlighted.

This paper explores the health rights of prisoners as defined in international law, and the mechanisms that have been used to ensure the rights of persons in detention to realise the highest attainable standard of health. It examines this right as articulated within United Nations and regional human rights treaties, non‐binding or so‐called soft law instruments from international organisations and the jurisprudence of international human rights bodies. It explores the use of economic, social and cultural rights mechanisms, and those within civil and political rights, as they engage the right to health of prisoners, and identifies the minimum legal obligations of governments in order to remain compliant with human rights norms as defined within the international case law. In addressing these issues, this article adopts a holistic approach to the definition of the highest attainable standard of health. This includes a consideration of adequate standards of general medical care, including preventative health and mental health services. It also examines the question of environmental health, and those poor conditions of detention that may exacerbate health decline, disease transmission, mental illness or death. The paper examines the approach to prison health of the United Nations human rights system and its various monitoring bodies, as well as the regional human rights systems in Europe, Africa and the Americas. Based upon this analysis, the paper draws conclusions on the current fulfilment of the right to health of prisoners on an international scale, and proposes expanded mechanisms under the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment to monitor and promote the health rights of prisoners at the international and domestic levels.

This article looks at the new legal framework for the regulation of residential and nursing home care. It focuses on the changes to the law, regulations and guidance and examines critically whether these changes are likely to lead to higher standards.

The Care Standards Act 2000 is designed to regulate and improve the management of residential care homes and other services. It provides a legislative framework for good practice, testing quality and enforceable minimum standards. In practice, its introduction has been difficult and providers have been closing homes. This article looks at the practical consequences for providers and identifies the positive and negative effects.

Southern Ireland faces similar challenges to the rest of Europe in that it has a rapidly increasing older population, seemingly infinite demand for health and social care and growing financial pressures. Against such a background, there are concerns about the quality of care provided for frail older people, especially in long‐term care settings. This paper considers some recent policy development in Ireland, with a particular focus on long‐term care. It describes the response to a series of inquiries about the quality of care in such environments and the subsequent formation of the Health Information and Quality Authority (HIQA). HIQA has just introduced a series of new inspections standards, and these are presented in the article. However, whilst these standards are to be welcomed, it is argued that standards alone will not result in improved quality unless there is also a recognition of the role and value of long‐term care as a positive care environment for older people.

The Care Standards Act 2000 was introduced in July 2000 and will come into force in April 2002. With only a few months to go, the Government has at last produced a raft of secondary legislation, which has to be in place by the time the Act is in force.

Approaches for the systematic evaluation of nursing practice are outlined. Practical methods and steps in auditing care at ward and individual patient level are discussed. Standard‐setting at ward level is systematically described and examples given. Monitoring and measuring outcomes and individual patient unit (IPA) are also described.

It is generally accepted that people in prison have a right to a standard of health care equivalent to that available outside of prisons. This “principle of equivalence” is one that enjoys broad consensus among international health and human rights instruments and organisations. However, given the extreme health problems evident in prisons worldwide, the legal obligations of the State to safeguard the lives and well‐being of people it holds in custody and the implications of poor prison health on overall public health, this article suggests that ‐ even if achieved ‐ standards of prison health care only equivalent to that in the community would in some cases fall short of human rights obligations and public health needs. The article argues it is time to move beyond the concept of equivalent standards of health care, and instead promote standards that achieve equivalent objectives. In some circumstances, meeting this new standard will require that the scope and accessibility of prison health services are higher than that outside of prisons.