The Keogh Review: a welcome return to 2008

A little over five years ago, just before the NHS was due to have its 60th birthday, I sat with several hundred other people in a hot hall in the Royal Horticultural Society in central London and watched Ara Darzi announce the publication of his Next Stage Review.

Drawing on the work of the Institute for Healthcare Improvement and the Institute of Medicine in the United States, it set in train a suite of activity, including initiatives in measurement, accountability, incentives, leadership and strategic planning, all designed with the shared goal to improve quality. His vision was of clinical and organisational leaders collecting data on quality and using it to continuously improve care.

As the NHS now enters its 66th year, how far have we got towards that vision?

In some places, fantastic work is going on to use service level data, including patient feedback, to diagnose and tackle problems with quality. The North West Advancing Quality programme is an oft-cited example, and there are many others. But yesterday's Keogh Review was right to stress that, in still too many organisations, the mechanisms and skills to lead quality improvement are sparse.

As we argued in our reports on patient-centred leadership and quality assurance post-Francis, quality improvement must be led by frontline staff with, in hospitals, boards. Boards must never allow their meetings to merely 'note' that month's quality report. They must approach their data with a spirit of challenge and inquiry – not to seek reassurance and move on. And they must collect, use and listen to the latest feedback from patients, families and staff, treating this information as a key source of early warning of quality slipping that is far more timely than hospital standardised mortality rates (HSMRs) or summary hospital-level mortality indicators (SHMIs).

The Keogh team's review methodology may offer a blueprint for the Care Quality Commission's new approach to inspections, but regulation can only ever be the third line of defence against poor care.

National organisations and initiatives can offer important support, however. In the new system, there are many organisations working to support boards to do what the best are already doing: there is the NHS Trust Development Authority, Monitor, the Care Quality Commission, NHS Improving Quality, and the National Quality Board for starters. In policy, we still have Don Berwick's Zero Harm Review and the government's full response to Francis to come later this year, and the beginnings of the Care Quality Commission's new approach to inspections and regulation.

Perhaps by the time the NHS is 66 we will be able to see, together with the Keogh Review, the return of a much-needed comprehensive and coherent national approach to quality improvement that will support boards and frontline staff to truly focus on what matters.