The NHS can only improve its quality of care and its culture if boards empower frontline staff, says new Foundation Trust Network chair Gill Morgan



Delivering high quality patient care is the main reason why people come to work in health and social care – and quality of care leads the agenda for the service today. With my background as a clinician-turned-manager, it’s great to be back in the NHS in England in my new role as chair of the Foundation Trust Network.

Throughout the time I spent working as the permanent secretary to the Welsh government, I kept up with all the changes that were happening on my old patch.

I’m very aware how challenging the situation currently is for everybody, and how hard organisations and their staff teams of all professions are working just now. Our members are having to deal with rising and extended demand and expectation, due to our population living longer and new technology: both a sign of the NHS’s success.

Image of Gill Morgan

‘Delivering a high quality service starts at the moment a patient first has contact with the NHS and continues in every subsequent encounter’

They’re also rightly facing the need to ensure all services that we deliver to patients are of both the highest quality and the right level of compassion at all times, while operating within the current constrained financial envelope.

I have been deeply impressed by how organisations have gone about tackling all those things.

On the policy agenda, providers are facing the broadest range of challenges for more than a generation – sustainability, quality, integration, service configuration – while dealing with an ever tighter budget. This is all taking place in the aftermath of the Francis report, which has had a huge and understandable impact on public interest how services are provided and generated a massive response from providers to ensure that quality, safety and patient experience and dignity are prioritised at all times.

This has led us to a defining moment. The best organisations have always had their main focus on quality. Now providers, commissioners and system leaders across health and care economies need to make sense of how to deliver this, at the intimate level of contact between patient and healthcare professional, at the local organisational level and across our systems and networks.

Quality, safety and dignity

This renewed focus on the quality, safety and dignity of patient care is the main reason I wanted to come back to the NHS, to help and support the FTN’s members. It is our members who are dealing with patients every hour of every day of the year, and on their behalf we need to ensure that their challenges and contributions to improving care are fully understood.

‘In the search for progress, all options have been considered, but that doesn’t mean they are all right, even if they are well intentioned’

For me, delivering a high quality service starts at the moment a patient first has contact with the NHS and continues throughout every subsequent encounter. Quality means we always put patient care first. Quality has to be delivered by individual frontline staff, owned by teams, supported by their organisation’s systems and processes – and led, monitored and celebrated by boards. Together this can give good outcomes and good experiences for the patients we treat.

Much was already changing before Francis; much has changed since and the pace of improvement has accelerated. We are constantly seeing patients, professionals and organisations testing, trying and getting on with making change and progress.

NHS spirit

This has been the spirit of the NHS for as long as I have known it, albeit one that hasn’t always had the space and support needed to flourish. I think the Francis report has changed that and given a new focus to our action.

It’s also understandable that in the search for progress, all options have been considered, but that doesn’t mean they are all right, even if they are well intentioned. For instance, there is a desire to deal with grossly poor quality through criminalisation. While this understandable, we already have a place for criminal investigation where the police and prosecuting authorities believe it is required.

‘Boards that encourage a culture of empowerment and involvement drive the highest standards of quality’

In reality, improving quality is only going to be driven by people driving these agendas from the coalface up to and through the board and being honest and transparent about what they do. Both Francis and the Berwick review rightly pointed out that getting the culture right is central to improving quality, safety and dignity.

Evidence suggests that clinical leadership and proper staff engagement and involvement raise the quality of care, and that involving patients, their families and carers more effectively also brings benefits.

The highest standards

The FTN’s members are improving service and quality throughout the NHS everyday. Just some examples are the inspiring work to engage and empower staff at Birmingham Women’s Foundation Trust; coordinating care and improving pathways for accident and emergency patients in Norfolk and Norwich; the reduction in callouts and admissions the North West Ambulance Service has achieved by case managing frequent callers; the national programme in which community trusts are leading the development of meaningful quality metrics for their services; and the innovative and creative ways in which Oxleas Foundation Trust involves mental health service users and other patients in sharing their experiences and shaping their own care.

These issues will be key themes of the FTN’s first Quality of Care Conference later this month, where Professor Michael West’s keynote speech will highlight the evidence that boards that encourage a culture of empowerment and involvement drive the highest standards of quality.

To deliver these improvements, we have to help people who come to work every day to deliver great care: to recognise and celebrate it when happens, as well as to tackle issues swiftly when we fail.

Dame Gill Morgan is chair of the Foundation Trust Network and the Alzheimers Society