Improving the quality of health care

Improving the quality of health care – ensuring that it is safe, effective and provides a positive experience for patients – has been central to policy-making in recent years. The challenge for the NHS in the next parliament will be to maintain this focus in a much tougher financial climate.

Strengthen the focus on the patient's experience

Significant progress has been made in treating conditions such as cancer and heart disease, and long waiting lists for treatment are now a thing of the past. However, the NHS is still not consistently good at 'seeing the person in the patient', and listening and responding to patients' feedback about their experience of care. Feedback from patients supports this; while surveys generally show high levels of satisfaction with the NHS, more detailed research with patients reveals a more patchy picture.

All the main parties talk about developing a more 'patient-centred NHS'. At a local level, boards, managers and clinical leaders must work hard to instil a culture focused on providing a positive experience for patients, supporting and enabling staff to deliver compassionate care. The government must support this by creating a performance framework that places value on improving patient experience and delivering the outcomes that matter most to patients rather than focusing on outputs and processes.

Intensify efforts to improve safety

The rates of the most common hospital-acquired infections have been driven down in recent years, while the collection and analysis of data about patient safety has improved significantly. Nevertheless, there is still some way to go before a strong safety culture is firmly embedded in parts of the NHS, particularly in primary care.

Although the reporting of incidents has increased – an essential step towards improving safety – there is still significant under-reporting in some areas. As the report into the failures of care at Mid Staffordshire Foundation Trust showed, NHS organisations need to focus on involving patients, the public and frontline staff in reporting safety issues. There also needs to be a more systematic approach to safety across all areas of the NHS, including maternity services.

Get smarter about measuring quality

There is now far more information about performance in the public domain, and recent years have seen a strong focus on measuring quality in the NHS. This is important for understanding, monitoring and driving improvements in the quality of health care, and is central to helping patients make informed choices. While quality measurement is reasonably well developed in some areas of care, it is lacking in others and still focuses disproportionately on the outputs and processes associated with care rather than on the outcomes of care for patients and their families. Measuring quality also raises complex and sometimes contentious issues: the quality of information available across the NHS is patchy and data can be manipulated and misinterpreted.

To address these issues, the government must prioritise the development of quality measurement in areas where it is currently lacking – including community and mental health services – support best practice in the development and use of quality measures, and clarify the roles of different national, regional and local bodies involved in using them. In many ways, it is patients themselves who are in the best position to judge the quality and effectiveness of the care they receive. The routine use of patient-reported outcome measures (PROMs) is an important step forward and should be developed for use across the NHS.

The King's Fund's work on improving the quality of health care

The quality of health care is a key area of work for The King’s Fund. We have undertaken extensive research and policy analysis to evaluate how to improve quality in health care. We are also closely involved in improving the delivery of high-quality services through our health care improvement programmes.