23.02.16
NHS needs ‘single quality strategy and national centre of expertise’
The NHS must become a “learning and high-performing organisation” by establishing a single, coherent strategy to improve quality of care, helped by a “modestly sized” national centre of expertise, the King’s Fund and major healthcare figure and Institute for Healthcare Improvement CEO Dr Don Berwick said.
In a report arguing that the NHS cannot meet healthcare demand without sustained commitment to quality improvement, the think tank made the case for a ‘single quality improvement strategy’ developed and supported by leaders of all relevant national bodies.
While the report welcomed NHS Improvement chief exec Jim Mackey’s case for more support and interventions for challenged trusts, it said the real experience of struggling providers “remains one of closer scrutiny of their performance and an ever-present risk that their leaders may be replaced”.
“That looming threat and the fear it induces are severe impediments to the proper pursuit of quality improvement, illustrated by the health secretary’s recent warning that provider boards will be sacked if they fail to bring budgets back into balance,” the think tank said.
“National bodies should share, and co-operate, in striving for robust, system-wide improvement activities. They should commit to major investments in innovation, such as the new care models programme, and to an evolving, jointly embraced vision of the new NHS care system as a whole.”
It argued there is already precedent for a single strategy in the Five Year Forward View, but it is now more important than ever to ensure the work of the CQC is fully aligned with that of NHS Improvement.
“For the avoidance of doubt, a national system of support should extend well beyond challenged organisations to enable all organisations to improve care and innovate at pace and scale,” read the report.
“As we argued earlier, the logical place to locate national expertise on quality improvement is NHS Improvement acting in partnership with other national bodies. This will require major changes in approach given the largely financial and technical orientation of NHS Improvement’s predecessor bodies, Monitor and the NHS Trust Development Authority.”
But the King’s Fund report also noted that involving and committing national bodies in developing the quality strategy is necessary, but “by no means sufficient”.
It is equally important to engage frontline clinical leaders of the regional organisations who already have a track record of achievement in quality improvement, the think tank said.
These leaders could then be involved in a “modestly sized national centre of expertise” alongside a “small number of focused teams like the Emergency Care Intensive Support Team”.
They would draw on experiences from within the health service in areas of care where external support is most needed, “thereby reducing reliance on expensive and questionably effective management consultants”.
“The centre would be a repository of intelligence about quality improvement to be called on by the NHS and it would signpost relevant examples and evidence from England and further afield,” the report argued.
“It would work with regional bodies like AHSNs [academic health science networks] and improvement networks and collaboratives such as AQuA [Advancing Quality Alliance] and UCLP [UCLParnters] to offer the structured advice and support needed.
“It would not detract from the primary responsibility of NHS organisations themselves to give priority to quality improvement and invest in building the capabilities required.”
Other recommendations made by the think tank, including the need for unified and co-ordinated support within the single strategy and to work with outside experts, can be read in the report.
(Top image: Don Berwick, c. Stephan Savoia, AP/Press Association Images)