UK: Putting High Quality Care Back At The Top Of The NHS Agenda

Last Updated: 7 March 2016
Article by Karen Taylor

Most Read Contributor in UK, August 2017

Since the start of 2016, bad news stories about the state of the NHS have proliferated, from a larger than expected deterioration in the state of NHS finances, to the junior doctors strike; alongside evidence of increases in waiting times, cancelled operations and bed occupancy figures. All pointing to an NHS under siege with concerns over quality of care increasing. The publication this week, of the King's Fund report on Improving Quality in the English NHS: A strategy for actioni, provides a timely reminder of the importance of building capability for quality improvement in each and every NHS organisation. This week's blog provides my take on the report and the discussion that accompanied its launch.

The King's Fund report argues that the NHS urgently needs to adopt a quality improvement strategy if it is to rise to the significant financial and workforce challenges it is currently facing. It defines quality improvement as designing and redesigning work processes and systems that deliver healthcare with better outcomes and lower cost wherever this can be achieved.

The report sets out 10 design principles to guide the development of a quality improvement strategy. This includes building in-house capacity for quality improvement, by committing time and resources to acquire the necessary capabilities and learning from the experience of trusts such as "Salford, Sheffield and Wigan where quality improvement is well established". It also recommends that organisations should work together through improvement collaboratives, and the importance of shared learning and mutual support. It highlights the achievements in the north-west of England's Advancing Quality Alliance and in London, UCLPartners academic science partnership.

A more contested suggestion is the proposal to establish a "modestly sized" national centre of expertise, learning from the experience of the NHS Modernisation Agency. While most of the audience at the launch appeared to wholeheartedly support the design principles, like a number of other commentators, I was less convinced about the need for a new central organisation. Believing that quality improvement needs to be owned by and generated by staff on the front line and that previous attempts at creating a central organisation with such a remit have largely failed to deliver the desired impact.

The report recognises the importance of staff buy-in to a coherent and unifying quality improvement strategy and the need to implement this in partnership with clinical leaders and managers who have practical experience of implementing quality improvement. During the discussion that followed the launch, there was a prevailing view that many of these change leaders are already out there in the NHS but that they need to be identified, empowered and supported.

It was acknowledged that those organisations that have been successful in achieving high quality care have focused primarily on identifying and reducing variations in clinical care and, where appropriate, standardising how care is delivered. Improvements have also been achieved by investing heavily in training and development of staff at all levels, and by accumulating many small positive changes over time rather than seeking a big breakthrough in performance.

Finally, the report argues that there is too much reliance on leaders in the NHS tightening their grip on performance and too little on the need to engage and support staff at all levels to play their part in delivering better value - "with tone in the middle as important as tone at the top". It suggests that unless the challenge facing the NHS is framed as a challenge to improve quality rather than to cut costs, staff will be demoralised rather than motivated, especially clinicians. Indeed it restates the evidence that Lord Darzi articulated in his 2008 review High quality care for allii, that quality not finance should be the guiding strategy of the NHS, while recognising that the results will take time to show, but that there is no better option for the NHS.

While I agree with the majority of the suggestions in the report, I'm less convinced about the overall conclusion that, despite a succession of well-meaning policy initiatives over the past two decades, the NHS in England has lacked a coherent approach to improving quality of care. Indeed I believe that over the last fifteen years there have been significant in-roads in raising the quality bar in the NHS. Some of the more notable initiatives which are referenced in the King's Fund report include:

  • Sir Liam Donaldson's 2000 report, An Organisation with a Memoryiii, which defined and popularised the field of patient safety
  • Lord Darzi's report High Quality Care for All
  • Hard truths: the journey to putting patients firstiv, the government's response to The Francis' Mid -Staffordshire inquiry.

In addition there have been numerous targeted initiatives on improving quality of services like the National Service Frameworks for Heart Disease and Cancer and the National Strategies for Stroke, Dementia and End of Life Care; all of which demonstrate evidence of improvements in patient outcomes.

However, I also know that governments have to respond to the changing political and financial environment, that people in influential positions move on, meaning that organisations often lack a corporate memory and have a tendency to re-invent wheels rather than building on what works and recognising what doesn't. Consequently, I do believe the time is right for a quality improvement strategy that once again focusses attention on the importance and role of quality to enable the best things about the NHS to be maintained, improved and adopted at scale.

Footnotes

i http://www.kingsfund.org.uk/publications/quality-improvement

ii http://www.gov.uk/government/publications/high-quality-care-for-all-nhs-next-stage-review-final-report

iii http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/publications/

iv https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/270368/34658_Cm_8777_Vol_1_accessible.pdf and https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/270103/35810_Cm_8777_Vol_2_accessible_v0.2.pdf

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
 
In association with
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
 
Email Address
Company Name
Password
Confirm Password
Position
Mondaq Topics -- Select your Interests
 Accounting
 Anti-trust
 Commercial
 Compliance
 Consumer
 Criminal
 Employment
 Energy
 Environment
 Family
 Finance
 Government
 Healthcare
 Immigration
 Insolvency
 Insurance
 International
 IP
 Law Performance
 Law Practice
 Litigation
 Media & IT
 Privacy
 Real Estate
 Strategy
 Tax
 Technology
 Transport
 Wealth Mgt
Regions
Africa
Asia
Asia Pacific
Australasia
Canada
Caribbean
Europe
European Union
Latin America
Middle East
U.K.
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.

Disclaimer

Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.

Registration

Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.

Cookies

A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.

Links

This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.

Mail-A-Friend

If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.

Security

This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at enquiries@mondaq.com.

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.