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Improving quality in the English NHS

A strategy for action


This paper argues that the NHS in England cannot meet the health care needs of the population without a sustained and comprehensive commitment to quality improvement as its principal strategy.

Despite a succession of well-meaning policy initiatives over the past two decades, the paper argues that the NHS in England has lacked a coherent approach to improving quality of care. It describes key features of a quality improvement strategy and the role of organisations at different levels in realising it, offering 10 design principles to guide its development. A quality improvement strategy of this kind has never been implemented at such a scale and the challenge in doing so is immense – yet the paper argues that the NHS has no real alternative.

Key findings

  • Successive governments have pursued policies to improve the quality of care in the NHS, but the many and varied initiatives failed through a lack of consistency and the distraction of other reforms.

  • Efforts to improve quality of care have been hampered by competing beliefs about how improvements are best achieved.

  • More than ever, the NHS must focus on delivering better value to the public. This means tackling unwarranted variations in clinical care, reducing waste, becoming more patient- and carer-focused, and ensuring that quality and safety are at the top of the health policy agenda.

  • This is best done by supporting clinical leaders through education and training in quality improvement methods, and developing organisational cultures where leaders and staff focus on better value as a primary goal.

  • Clarity about the role of inspection in a quality improvement system is vital. Done well, inspection has a part to pay in quality assurance – but this should not be confused with quality improvement.

Policy implications

  • A quality improvement strategy that defines the roles of organisations at different levels in supporting improvements in care is needed for the NHS in England.

  • Politicians and leaders of national bodies must reduce the burden of regulation, inspection and performance management to free up clinicians and organisational leaders to work on improvement.

  • More emphasis is needed on developing cultures committed to improvement and learning from within the NHS – building in-house capability for improvement – rather than complying with external standards.

  • To transform the NHS into a learning and high-performing organisation will require resources and expertise, alongside an openness to learn from organisations around the world that have reformed from within.

  • A pragmatic, real-time evaluation of the quality improvement strategy and its implementation is essential.

Speaking at our breakfast event on 23 February 2016, Maxine Power, Director of Innovation and Improvement Science at Salford Royal NHS Foundation Trust, discusses how we can best support NHS leaders to bring about quality improvement.