The NHS’s cup is not running over as the service enters a period of increasing financial pressure, but the vintage laid down last year offers the best hope for everyone’s future

This time last year Simon Stevens compared the recently published High Quality Care for All to a vintage wine. “As wine experts will occasionally admit”, he wrote, “it’s hard to know how a new vintage will perform. Wines age, maturation takes time”. One year on, the reforms that came out of the next stage review are showing great promise but, like a good wine, they will only improve with time.

At the core of my report was one simple yet radical idea: to put quality - defined as patient experience, clinical effectiveness and patient safety - at the heart of the NHS.

This came towards the end of a decade during which the NHS had seen unprecedented levels of investment and reform. The purpose of my report was to introduce a new long term vision of how to make best practice the minimum we expect of ourselves, not the exception. Sitting at the centre of the system we are putting in place the tools and the structures that will enable this to happen, but the real change has to come from within the NHS itself, with local leaders and clinical teams defining what quality means for them and their patients, and pursuing that goal relentlessly.

We have already delivered on some of the report’s most significant policy commitments. I could go on with many others, but I think the message is already clear: the outputs of High Quality Care for All are already transforming the system. However, before this promising young vintage can become a great one there is still much we have to do. I believe that if we are going to fulfil our ambition of truly putting quality at the heart of everything we do then there are still some challenges we need to overcome.

That is why I am also keen to highlight the areas where I think there is more to be done. Confronting these challenges, as we enter a period of increasing financial pressure for the NHS, will require both thought and effort at all levels of the system. Our new health secretary, Andy Burnham, has already made it clear that he believes the best route to efficiency is through quality. This view is already shared by many across the system, and the need to put it into practice is more urgent than ever before.

My colleagues and I are fully committed and working hard on the tasks that still lie ahead of us. Only time will tell the extent to which we achieved our aims, but we are on the right track.

Five greatest successes

  • We created five academic health science centres to work on developing thought that contributes to clinical outcomes.
  • We launched the commissioning for quality and innovation (CQUIN) framework to link provider income to quality, putting quality at the heart of the conversation between commissioners and providers.
  • We introduced a £200m innovation fund, £20m challenge prizes and the NHS Evidence web portal - tools to enable innovation across the system as the strategic health authorities enter a new era where they have a legal duty to promote innovation.
  • More than 152 GP-led health centres have already opened across the country. Along with extended hours opening, this represents a radical increase in access to primary care and the services they are able to provide.
  • We have founded new national bodies, such as the National Quality Board and the National Leadership Council. These put clinical and non-clinical experts together to oversee and align the work that is going on at a strategic level across the system.

Five greatest challenges

  • There is still more work to be done in promoting clinical leadership across the system, making clinicians and their teams more responsible for budgets and outcomes.
  • We have put in place the elements of the quality framework, such as quality accounts and indicators; measurement against these structures will enable teams to improve the care they provide.
  • We celebrate the NHS’s history of innovation, but it is often undermined by lack of support for adoption of these new technologies and practices. We need to see innovation as an opportunity rather than a threat, and learn to embrace it in our daily working lives.
  • Health innovation and Education clusters will be launched in the autumn, and have a great potential to reshape our medical training and the way we partner with universities, businesses and the third sector to inform and improve what we do. Making a success of these will require effort from all involved.
  • Lastly, I believe that the service needs to consider how to increase productivity through its improvements in quality. This is especially important in the current economic climate, and recognition of this will be the only way for the service to make it through the years ahead.