The Scalpel's Blog


Ensuring quality in the new NHS

Dr Marion Andrews-Evans, member of the NHS Clinical Commissioners (NHSCC) Nurses Forum steering group and executive nurse & quality lead at NHS Gloucestershire CCG, sings the praises of CCG quality leads who are working in often unseen roles to help deliver safe and effective patient care.

As the NHS goes through a time of change, we need to make sure that the quality of services that we provide for patients is protected. Patient experience and safety has to be paramount both in the present and when planning for the future. The question is, in the new world of sustainability and transformation partnerships (STPs), accountable care systems (ACSs) and other evolved commissioning systems, who will make sure that patient experience and safety remain a top priority?

Currently, it is the responsibility of the CCG board lead for quality. When CCGs were set up in 2013, one of the key legislative responsibilities was – and still is – to secure improvement in the quality of services provided in their area. Making sure this happens falls to the quality lead, a role in many cases fulfilled by a nurse. The role is a key one to protect patient care.

However, a number of members of the NHSCC Nurses Forum have raised concerns that in some STPs it has been intimated that this independent, objective function with a focus on quality is no longer needed. Instead, the argument goes that the ACS can monitor and improve the quality of services they provide with scrutiny falling to the CQC.

This won’t replace the huge amount of vital work that CCG quality leads carry out. Fundamentally, they stop things going wrong; unfortunately, this is why often their work goes unseen and their contribution to the safe and effective running of healthcare services is overlooked. They lead an often-hidden workforce in CCGs, made up of nurses and/or other clinical professionals who spend their days working to promote patient safety and clinical effectiveness.

As well as focusing on the patient’s experience and engaging with the public about their health services, they work closely with providers both within the NHS and those outside its boundaries including care homes, private hospitals and commercial community service providers to improve service quality. Wherever a patient accesses healthcare they should expect the same standard; the CCG quality lead works to make this happen.

In this changing landscape, this role is becoming more important than ever. It is well documented that when providers are developing new systems and models of organisational delivery, finances are stretched, or staffing levels are challenging, service quality is inevitably affected. As we approach the next stage of the STP process, all of these challenges are on the agenda. In this ‘perfect storm,’ patient care can become compromised. The risk of this happening will increase considerably if the role of the CCG quality lead in providing a system-wide independent view of assuring and improving quality across all health and care providers is diminished. It must be protected if we are to ensure that the best interests of the patients remain at the heart of our local healthcare services.


Cathy Balding   12/09/2017 at 07:54

This appears to be a world-wide conversation! I can understand the argument. But are we ready to ditch finance directors because managers should be responsible for and know how to manage their budgets? It's the same thing. Quality systems leadership and management is a technical speciality. Someone has to develop, implement and manage the quality systems that support managers and staff to fulfil their responsibility for providing high-quality care. They are complementary roles.

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