The Quality 2020 strategy: parallels with Francis

Last Friday I attended the steering committee meeting for the Northern Ireland Quality 2020 strategy. The strategy, developed in 2011 and approved following consultation, has many parallels with the agenda set out for the NHS in England by last week's Francis report. 

Whether this is a result of foresight on the part of the Northern Ireland Department of Health, Social Services and Public Safety or simply testament of the similar challenges facing health services across the UK, there will certainly much that each of the devolved health and social care systems can learn from each other.

Quality 2020 focuses on five themes:

• Transforming the Culture – the role of leadership and partnership in driving innovation and change.
• Strengthening the Workforce – the need to continually develop the skills and knowledge of the entire workforce in order to deliver high quality care.
• Measuring Improvement – the urgent need to address the challenge of developing meaningful measures of quality.
• Raising Standards – the need to have consistent expectations of the standard of care patients and clients can expect wherever they are in the system.
• Integrating the Care – that Northern Ireland's integrated health and social care Trusts provide an effective platform for genuinely delivering person-centred care.

What made my visit to Belfast exciting was that the strategy is more than good ideas on paper, it is already being put into practice as I saw at the South Eastern Health and Social Care Trust. 

Covering apopulation of 440,000 located to the south east of Belfast, the Trust has set out a combined vision to simultaneously raise standards of all care and to shift care from the hospital setting into communities and people's homes.

The Trust's Chief Executive, Hugh McCaughey, recognises that while targets have their place, they don’t always incentivise the right behaviours and engage clinical teams. He is leading a process in which all clinical departments are developing their own measures of quality and taking responsibility for improving them. Underpinned by a sustained capacity building programme that will see multiprofessional staff from across both health and social care skilled up in quality improvement techniques, this genuine bottom up approach is already leading to fundamental service redesign.

In the Emergency Department, for example, a set of 24 measures – built around professional standards and factors that the team knows matter to their patients – is being used to identify areas for improvement with members of the entire multi-disciplinary team from nursing staff to porters and medics, leading joint and individual projects. These include areas include: sepsis, left before treatment, stroke, unscheduled re-attenders, patient experience, ambulance triage and key priority indicators for nursing in the observation ward.

This work is highlighting the need and opportunity to take care 'upstream', supporting people to stay well and manage their own health effectively. Through a partnership with the Basque Health Department, the Trust is taking the lessons from the Basque 'chronicity strategy' to redesign care for people with long term conditions – creating activated patients being central to this.

Everyone working in healthcare is facing significant challenge – it's great when you see this challenge being met with hope, optimism and a real sense of possibility.

Jo is Director of Strategy at the Health Foundation.