Comment

Time for change – rising to the challenge of delivering top quality, affordable healthcare for all

Julian Hartley, managing director at NHS Improving Quality (NHS IQ), describes the establishment, strategy and vision of the new organisation.

The NHS is going through perhaps the most significant and wide-reaching changes since being created in 1948. It must adapt to the needs of the people it serves, recognising that while we are living longer, we are doing so with increasingly complex health requirements.

With financial constraints and no growth in resources, the NHS needs to radically change and improve the way we do things. We need to deliver wholesale improvement and high quality services at scale and pace to meet people’s needs and exceed their expectations. NHS IQ will help achieve this by supporting health outcomes across England through improvement and change expertise.

Since our launch on 1 April 2013, we have been working to create a world class, sustainable improvement resource. This will enable frontline services to improve quality around clinical effectiveness, safety and people’s experience of care.

Creating broader, faster change

We know that the ability to drive change in the NHS exists. What we now need to do is to coordinate, amplify and reinforce our change efforts in order to achieve significant benefits across the entire NHS. NHS Improving Quality is committed to making this happen.

As the driving force for improvement across the NHS, NHS IQ brings together a wealth of knowledge, expertise and experience, while establishing a new vision and re-shaping the healthcare improvement landscape. In forming NHS IQ, we have taken on board the lessons of history and the experience of previous national improvement teams.

However, the operating model of NHS IQ is different to previous improvement organisations in a number of ways:

• We are fully aligned to and hosted by NHS England, and designed to identify and respond to its improvement requirements.
• We are a smaller, more streamlined organisation than previous improvement bodies, with a focus on designing improvement interventions and commissioning these through a range of delivery partners.
• We have a whole system responsibility, including offering improvement support to NHS organisations and networks.
• Our work brings together the key stages of the improvement cycle; creating a forward view, proof of concept and testing, designing for delivery, and delivery and deployment.
• We have geographical reach to support NHS England’s regional and area teams and Clinical Commissioning Groups (CCGs).
• We will support challenged NHS organisations through NHS Interim Management and Support (NHS IMAS), which forms part of NHS Improving Quality.

Our priority areas

For the first time the NHS has an improvement body that is fully aligned to its commissioning priorities as expressed through the five domains of the NHS Outcomes Framework:

1. Preventing people from dying prematurely
2. Enhancing quality of life for people with long term conditions
3. Helping people to recover from episodes of ill-health or following injury
4. Ensuring that people have a positive experience of care
5. Treating and caring for people in a safe environment and protecting them from avoidable harm

Ten key programmes of work have been identified, which map against these five domains. We are now establishing a range of delivery partners, including a Delivery Team comprising of experienced improvement staff, which we will commission to support NHS organisations in delivering improvement. These may include Academic Health Science Networks, voluntary, policy, academic and commercial organisations, Royal Colleges and charities, as well as NHS organisations and alliances. We are also keen to hear about examples of service improvements you have been involved in locally or regionally that could help inform our work.

How should we organise our key resources for improvement?

At NHS Improving Quality, we recognise that in order to successfully implement effective improvement programmes to support the NHS Outcomes Framework, we need to build improvement capacity and capability across the whole system.

A single improvement methodology including the NHS Change Model is being rolled out across NHS England, including senior leaders and regional area teams, Clinical Commissioning Groups (CCGs) and primary medical care. This ensures that improvements are sustainable and deliver real benefits, in line with the NHS Outcomes Framework and NHS England’s strategic plan Everyone Counts: Planning for Patients.

Over the next 12 months, every senior leader of NHS England will be offered the opportunity to be a role model of transformational leadership by undertaking an accredited improvement capability building programme. As well as this, all NHS England area teams will be offered the opportunity to build capability for transformational change through coaching, master classes and action learning sets. All NHS England staff will have access to a foundation level, e-learning programme to ensure everyone has basic capability in the NHS Change Model and improvement methodology for commissioners.

The time for change is now

Over the past decade, the NHS in England has seen much positive change, including reductions in waiting times for elective care, a fall in infection rates and a significant reduction in hospital mortality – all as a result of a systematic approach to improvement.

With support and engagement from across the healthcare system, NHS Improving Quality will build on this work and act as a catalyst to drive transformational change across the NHS.

In doing this, we will create innovative and new knowledge of how to achieve sustainable change.

We look forward to working collaboratively to ensure that our NHS continues providing top quality, affordable healthcare for all.