Background
The quality of health care has always been a central focus of the NHS. But in the early days of the service this tended to be implicit, relying on the self-regulated professionalism of its clinicians, rather than being subject to explicit standards.
That began to change in the 1990s, partly as a result of increased public expectations and partly because of a number of medical scandals culminating in the avoidable deaths of a number of babies at Bristol Royal Infirmary between 1985 and 1995.
In its White Paper, The New NHS: Modern, Dependable, in 1997 and the follow-up consultation document A First Class Service: Quality in the new NHS in 1998, the previous government pledged to place quality ‘at the heart of the NHS’, stating that ‘high quality care should be the right for every person in the NHS’.
New structures were created at national and local level to ensure the highest quality standards were achieved. National clinical standards would be laid down through a range of new National Service Frameworks in key clinical areas such as diabetes, cancer and heart disease. The National Institute for Clinical Excellence (NICE, now the National Institute for Health and Clinical Excellence) was set up to establish clear, evidence-based guidance on which drugs and treatments were effective. And these standards would be delivered locally through clinical governance, a method of quality assuring a trust’s clinical decisions, backed up by a new statutory duty of quality.
Trusts’ performance in achieving these standards would then be monitored by a new independent inspection body, the Commission for Healthcare Inspection (CHI). There would also be an annual national survey of patient and user experience in the NHS.
In 2001 the Labour government introduced a star rating system to measure trusts’ performance against certain targets. This system was modified soon after the CHI’s successor, the Healthcare Commission, took over in 2004. They introduced an annual ‘health check’ based on a wider range of self-assessed measures of performance, with greater weight given to the patient experience.
The Department of Health also introduced a series of key health care standards for quality of care in England in 2004. These consisted of 24 core, or mandatory, standards plus a further 10 developmental standards that were seen as more aspirational.
The quality agenda was given its most recent boost by the NHS Next Stage Review, led by Lord Darzi and launched in July 2008. Darzi’s reforms introduce a plethora of new quality measures with the aim of shifting the emphasis once and for all ‘from quantity of care to improving quality of care’.
The coalition government emphasises the importance to patients in being able to access information on quality. It plans to enable patients to rate hospitals and doctors according to the quality of care they receive and to publish data on the performance of hospitals online (The Coalition: our programme for government)
