Watching quality

In the last year or so you might think that quality in the NHS has been scrutinised more than at any other time since 1948. With reports from Francis, Don Berwick, the CQC and the Keogh Review, and initiatives such as quality accounts, outcomes frameworks, Quality Surveillance Groups, HealthWatch, huge amounts of information from the NHS Information Centre, numerous patient surveys, the friends and family test results and clinical audit...surely we don’t need more analysis?

But we do, which is why we have joined forces with the Nuffield Trust to track quality over the next five years in a programme of work called QualityWatch, which released its first findings last week. So why do we need more analysis?

First, as everyone knows, the money for health (and social) care is tighter than it has been for decades. As costs are easier to measure than quality, all eyes should be on how cuts or efficiencies are affecting quality – where, how and on whom. This is not just to spot and intercept deteriorating care, but also to see where quality may be enhanced and show others how it is done.

Second, quality of care is a complex concept, and the statutory quality-measuring agencies may not be able to capture this complexity. For example, we are only now learning how best to measure quality across providers and how best to involve public and patients. And the impact of care not being received because of poor accessibility is hardly measured at all.   

Third, while there are a lot of ‘dashboards’, many measure similar things. There is still room for creative analysis, for example involving data linkage in individuals, examining cohorts and carrying out longitudinal analysis.

Fourth, what gets measured gets done. In large tracts of care there is hardly any information on quality, and often this is forgotten.

And fifth, there is a dearth of organisations with no obvious vested interest to assess quality and to report this nationally.

The QualityWatch initiative has two parts: a longitudinal analysis of a set of indicators that will develop over time and report at least annually; and deeper probes into a few key topics each year.

Some early headlines from QualityWatch show that, despite frozen real terms growth in NHS funding since 2010/11 and deep cuts in local government, the quality of NHS care seems to be bearing up: patients are not reporting a poorer experience of care, measures of harm (including hospital acquired infections) generally are low, as are waits for care, compared to in the past.

The creaks in the system seem most obviously to be in urgent care – the rate of emergency admissions for ambulatory care sensitive conditions is rising, and waits in A&E waits for discharge from hospital growing slightly.

So far so good, perhaps. Monitor’s recent analysis of the funding gap comes to the plausible conclusion that there is no one solution to closing it. Rather, there will have to be effort across a number of fronts – even more reason for comprehensive analysis of quality.

Next month the Care Quality Commission will report on the annual state of care. Towards Christmas, QualityWatch will join forces with them and others who have a national take on quality to try to gain a consensus view of the overall picture, and will try to do this each year. You can keep tabs on the latest on the QualityWatch website.

Jennifer is Chief Executive of the Heath Foundation