Do we now have a basis for a coherent quality strategy in the NHS?

The end of last year saw the publication of a significant new policy document: the National Quality Board’s (NQB’s) Shared commitment to quality.

You may not be hugely familiar with the NQB: the Board was originally established in 2008, following Lord Darzi’s NHS Next Stage Review. It survived a change of government in 2010, but then went quiet before being revived in 2014 via the Five Year Forward View.

Throughout the last eight years, the NQB has worked to corral the efforts of the various national bodies with functions related to quality to make sure that, in aggregate, a coherent approach is taken.

But that’s proved no easy ask and, as we usher in 2017, is arguably now more challenging than ever.

Most obviously, the health service faces mounting pressures. Demand continues to grow and performance against key targets has deteriorated, while funding remains heavily constrained following a sustained squeeze in the last parliament. Spending on public health is due to fall in real terms by 2020/21 and social care is increasingly struggling to meet the needs of older people, their families and carers.

But also in the mix are the reforms initiated in 2010’s Equity and Excellence: Liberating the NHS white paper. This marked a major shift in health system governance, with a number of functions previously undertaken by the Department of Health distributed across a range of arm’s-length bodies.

And, as if moving a new, more complex and more fragmented, system wasn’t enough, the way that new system is now being run has shifted substantially away from the original vision behind the reforms.

That’s partly a consequence of the government’s response to the Francis Inquiry and other high-profile failures of care. See, for example, the radical changes to the Care Quality Commission’s regulatory model. The pressures of the most austere decade in NHS history, meanwhile, have driven the development of new models of care and – more recently – Sustainability and Transformation Plans. None of these changes were even on the agenda in 2010.

All of this means that having an effective mechanism for coordinating and aligning national plans and actions is absolutely critical.

However, in the context of a complicated and still-evolving system, it isn’t surprising that the Health Foundation’s research with Professor Sheila Leatherman found the current approach to improving NHS quality in England isn’t particularly coherent.

Our report – published 6 months before the Shared commitment to quality report – suggested that national bodies haven’t always worked well together, and that they need to set aside narrow, organisational interests to focus on developing a single, coherent and compelling quality strategy for the NHS in England.

Developing such a strategy doesn’t mean doing more – extra priorities, new policy initiatives, mandating the production of another set of local plans, and so on. All the hallmarks, in other words, of virtually all the major policy documents directed at the NHS in England.

In fact, pursuing a coherent strategy may mean doing less, with the national bodies taking a collective approach through a single definition of quality, a shared set of quality goals, a core set of metrics, etc. It also means investing finite time, money and effort in approaches that are most likely to work to improve quality, rather than making decisions based on ideology or personality.

In some ways, this should just be business as usual – but endeavours that rely on strong, constructive relationships are rarely easy, and generally don’t succeed overnight.

So there’s much to like in Shared commitment to quality: the organisations represented on the NQB have committed to promoting quality in everything they do, and coordinating their actions. The document articulates a single definition of quality, which had been lacking before. And it doesn’t succumb to the temptation to add to the NHS’ to-do list.

This is, of course, just a first step in a long road ahead. The real test will be  whether the NQB and the national bodies can demonstrate the behaviours articulated in Shared commitment to quality when the chips are down. As the old joke goes, only nuns change their habits overnight.

Nevertheless, Shared commitment to quality is a definite and important step forward, offering grounds for starting 2017 in a more optimistic frame of mind than its predecessor. Watch this space…

Tim Gardner (@TimGardnerTHF) is a Senior Policy Fellow at the Health Foundation