Aneurin Bevan’s famous dropped bedpan continues to echo through the corridors of Whitehall, defying various attempts to improve the soundproofing.
But the reverse is also true. The reverberations of policies made in Whitehall are often felt throughout the NHS. As are the decisions, plans and actions of the various arm’s-length bodies that now populate the national tier of England’s health system.
And when it comes to driving improvements in care quality, the centre of gravity has shifted decisively towards the national bodies and away from Whitehall. That’s why our new analysis published today calls for those organisations to jointly develop and lead a coherent national quality strategy.
The much maligned 2012 Health and Social Care Act marked a major shift in the national governance of the English NHS. And, through the Five Year Forward View the national bodies have already taken up the baton.
The Forward View set out a shared vision for the future of the health service and is a positive example of how these organisations can work together to provide strong national leadership. Turning that vision into reality, though, requires a coherent strategy for achieving high-quality, affordable care now, as well as supporting the development of the NHS in the longer-term.
This is a tough period for the health service, and the recent vote for the UK to leave the EU adds to what was already an uncertain and complex climate. The Health Foundation’s analysis of the possible impact on NHS finances highlights difficult decisions that may well lie ahead. This only makes the case for a robust strategy on quality more compelling, to support the health service to get the maximum quality bang for the taxpayers’ buck.
Our report has benefited from frank conversations with a large number of senior system leaders, and I don’t doubt their shared commitment to achieving high quality care for all. However, turning a commitment to quality into better outcomes for patients can be more difficult. A recent OECD review rightly recognised England (and the other countries of the UK) as a global leader in quality monitoring and improvement, but found that hasn’t translated into consistently strong performance on international benchmarks of quality.
The formulation and implementation of national policy is, of course, just one among many factors in the enormously complex relationship between everything we put into health care and the quality of care that results.
Other factors – the dedication and talents of the 1.4 million people who work in the NHS, for example – are arguably more powerful as a force for improving quality. In some cases providers have managed to pull off transformational change despite the system rather than because of it. But to dismiss policy as unimportant – or even irrelevant – would be a mistake.
Policy decisions can have direct impact on the people and organisations providing care, ranging from the dramatic to the more mundane, as well as influencing the climate in which health services are planned, delivered and overseen. Done well, policy should help to support locally-led service improvement. And doing it well shouldn’t be rocket science.
Our report identifies some practical steps that would help to bring about greater strategic coherence to national activity on quality. This includes having a shared definition of quality, a single set of quality goals and a core set of metrics. We also highlight pointers from the evidence base that can guide policymakers towards some ‘best bets’ of the array of available policy levers for improving quality.
Implementation of the 2012 Act has undoubtedly made the structures of the health service in England more complex. There are now more national players with involvement in the quality agenda, none of whom has a monopoly on quality. This isn’t ideal, but major change doesn’t seem likely to feature on the legislative agenda anytime soon so we need to work with what we’ve got.
Despite this, England – unlike many other countries – still has a relatively unified health system where it is possible to construct an overall quality strategy. The necessary levers for designing, planning, coordinating and implementing the main elements of a coherent strategy are still all there – the ability to pull them now is simply more distributed across a larger number of organisations.
My general outlook on life is that the glass isn’t even half-full. But when it comes to developing a coherent quality strategy to support and enable change, and provide an enabling environment, it doesn’t take an optimist to see the potential for the English NHS to be world-leading.
Tim Gardner (@TimGardnerTHF) is Interim Director of Policy at the Health Foundation