Key points
- The general definition of quality used by the NHS comes from Lord Darzi’s NHS Next Stage Review which defined quality in three parts: clinical effectiveness, safety and patient experience.
- The coalition government has proposed the creation of an NHS Outcomes Framework which will span these three areas of quality. The framework will be made up of a set of national outcome goals which can be used to hold the Secretary of State to account for the overall performance of the NHS. In turn, the Secretary of State can use the framework to hold the NHS commissioning board to account. Proposals for the NHS Outcomes Framework are currently being consulted on (see Transparency in outcomes, a framework for the NHS)·
- The coalition government emphasises the importance to patients in being able to access information on quality. It plans to enable patients to rate services according to the quality of care they receive and to publish data on the performance of hospitals online (The Coalition: our programme for government)
- The National Institute for Health and Clinical Excellence (NICE) produces national guidance on which treatments,drugs and procedures should be provided by the NHS.
- Under coalition government plans NICE is to produce 150 quality standards for the main pathways of care over the next five years. These standards should be easy for patients to understand and are to be reflected in contracts and financial incentives used by commissioners. The Health Bill to be introduced in 2010 will put NICE on a firmer statutory footing and will extend its remit to social care.
- Patient-reported outcome measures (PROMS) provide detailed feedback from patients on their experience following a procedure, on measures ranging from mobility and pain to mental health and overall health. The first set of PROMS – covering hip and knee replacements, hernias and varicose veins – was published in April 2010.
- Clinical Dashboards' designed to provide simple, easily accessible graphic representations of the performance of a trust or department are increasingly being used by providers across the NHS.
- NHS trusts and provider organisations are expected to publish annual ‘quality accounts’ similar to their financial accounts. These accounts are intended to improve public accountability and increase boards' focus on quality. These accounts will be extended to all providers of NHS care from 2011
- The Care Quality Commission, which began work on 1 April 2009, brings together three previous inspection bodies – the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. Its role is to regulate for safety and to ensure minimum standards. It has greater powers than its predecessors, including the right to close down organisations and make unannounced spot checks. Now all health care as well as social care providers have to be registered to ensure common standards of quality and safety.
- It may be increasingly challenging for boards to focus on improving quality when under extreme financial pressure. However, an increased focus on quality does not necessarily mean increased costs. Indeed, much quality improvement could in fact improve productivity and save money.
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