Keeping safer service delivery at the forefront of the NHS

Commenting in relation to an evaluation of the Safer Patients Initiative, former Luton and Dunstable Hospital Foundation Trust chief executive Stephen Ramsden recently said: “A complete change in mindset is needed to convert ‘first do no harm’ into proactive action at every level.”

His point is that unacceptable variation in quality is still present in many hospitals.

The science of quality improvement is well documented and the absolutely crucial need to focus on the “human issues” is clear and well articulated in examples such as the human factors model. But how do we ensure this runs through the new world of the NHS we are entering?

One of the most fundamental yet challenging issues for commissioners is the “first do no harm” value, which must be part of our organisational DNA. But all too often we have been thwarted by the collusion of mediocrity; the gradual attrition where being average is seen as acceptable gnaws away at us, lowering expectation.

So how will consortia rise to this challenge, particularly through the time of transition? Some commentators will perceive this as a significant risk. I believe, however, it is the impetus we need to drive safety and quality ever harder through the commissioning process.

Consortia have a golden opportunity to ensure they develop organisational foundations that are fertile breeding grounds for quality improvement. Organisations that excel at improving quality will have a clear and consistent vision of high quality care and recognise that this is only achieved through continual engagement of frontline clinical staff.

Their leaders are passionate about driving up quality and engage their clinicians in driving out unwarranted variations in clinical care. Education and training in health improvement are the foundations on which success is built with teams of doctors, nurses and managers working closely together.

There are many excellent examples of such organisations within the NHS, and they are often providers. But the factors for their success will map over to other industries and organisations. Clinically led commissioning is all about outcomes and driving up standards – this is the compass by which we must navigate.

So what next for consortia? There needs to be a focus on the softer aspects of organisational development; yes, technical commissioning skills are important but others can support you in those areas; quality and safety improvement must be your raison d’être.

We have seen some excellent examples of leadership, with GPs walking the wards in hospitals and using patient stories to root out mediocrity wherever it is lurking: leadership from the front line.

Consequential to this is the absolute need to abolish the “great divide”. For too long the division between primary and secondary and also community care has not served us well. The quantum leap in safety is delivered when the whole works as a team across boundaries. Let’s not forget the strategic commissioning issues that consortia must confront in the cold light of outcomes.

There have been several well documented examples of strategic decision leading to significant improvements in quality of care. For example, the recent changes to stroke services in London; clinically led but also strongly supported through the commissioning route by the strategic health authority. The implementation of angioplasty services for ST elevated heart attacks; again clinically led through networks but also driven strongly through the commissioning process by SHAs and primary care trusts.

These changes occurred because of strategic commissioning decisions. Consortia must ensure that the beacon that guides them is quality and at times that will take them into challenging places. But they must rise to the challenge.

Consortia have a golden opportunity; this is what clinically led commissioning is all about.

Finally, let’s not forgot the quality of primary care; how will consortia drive this forward? The King’s Fund report on improving quality of care in general practice, led by Sir Ian Kennedy, is essential reading for all consortia.