A clear road ahead

Creating a coherent quality strategy for the English NHS

July 2016

Aoife Molloy
Sara Martin
Sheila Leatherman

Key recommendations

  • articulate a single set of quality goals and common definition of quality
  • provide unified national leadership for quality
  • build on experience and evidence
  • update a set of core quality metrics
  • articulate a shared understanding of how improvements in quality and costs are linked – and pursue both in tandem
  • provide unified regional leadership for quality
  • inform the future quality agenda.

Every health system should have a strategic and coordinated approach for delivering high quality health services within finite resources. Through the NHS, England has the potential to be a world leader in this.

A clear road ahead is the result of a project by a team from the Health Foundation, working with Professor Sheila Leatherman – whose previous work on a national quality programme fed into Lord Darzi’s NHS Next Stage Review – to recommend how the different parts of the NHS should work together to support and accelerate improvements in quality of care.

The report recommends creation of a single, coherent and compelling quality strategy for the NHS in England. This needn’t be a bureaucratic exercise that results in a one-off plan which gathers dust on a shelf. It can be an iterative, living approach based on a shared understanding of a framework leading to a clear ‘road’ ahead.

In the first instance, the new quality strategy could form the means to implement current priorities on quality. In the medium term, however, it could become fully embedded as a strategic framework for driving improvements in quality across the health service, in a balanced and coherent way.

A clear road ahead sets out a practical and feasible set of actions for policymakers to safeguard and improve care within current priorities, as well as support the development of the NHS for years to come. It recommends that national bodies undertake coordinated action to:

The recommendations in the report are informed by an assessment of the organisations, initiatives and approaches to improving NHS quality in England and an analysis of the impact of selected national initiatives over the last two decades.

As the NHS faces an increasingly uncertain and complex outlook, the need to ensure the health service has a robust approach to improving quality has never been more pressing.

Further reading


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