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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.

Related audio

<p class="o-type-intro">Speaking at our <a href="/node/6014">breakfast event</a> 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.</p>

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