Exclusive: NHS needs national centre for quality improvement, says report

The report, co-authored by Don Berwick, who previously reviewed NHS patient safety, called for a shift away from “regulation, inspection and performance management” as the principal method of NHS quality improvement.

However, King’s Fund’s chief executive Chris Ham told HSJ that attempts by the Department of Health and NHS national bodies to tighten their “grip” on deteriorating finances and performance was eroding the freedom of NHS organisations.

The King’s Fund report, shared exclusively with HSJ, sets out recommendations for a new NHS strategy for quality improvement – which it defines as designing and redesigning processes and systems to deliver better healthcare outcomes at lower cost. The report was also co-authored by Health Foundation chief executive Jennifer Dixon.

It calls for the creation of a “modestly sized national centre of expertise”, and says that previous agencies, such as NHS Improving Quality, have “struggled to establish themselves as valued sources of expertise”.

Professor Ham told HSJ that the health service’s existing quality improvement architecture was “fragmented and incoherent”, with expertise “scattered” between Health Education England, which now hosts the NHS Leadership Academy, NHS England and NHS Improvement.

The report calls for expertise in quality improvement and leadership development to be brought together in a single centre which could also provide advice on the implementation of the Carter review of NHS productivity.

It says the “logical place” to put the new centre would be within NHS Improvement.

The report says the government’s response to the Francis inquiry, such as the beefed up Care Quality Commission inspection regime, “exemplified the view that central control was the route to quality improvement”.

However, it criticises reliance on inspection as “too costly, too weak and inimical to dynamic change”.

Instead the report calls for politicians and the leaders of national bodies to “reduce the burden of regulation, inspection and performance management” to give clinicians and organisational leaders the freedom to drive improvement themselves.

Professor Ham said the CQC’s consultation on its new strategy was a “welcome” opportunity to move regulation in a “more realistic direction”, but he claimed there was a split in the organisation about the value of inspection.

“Some [CQC leaders] absolutely get what we’re saying in our paper and would like to give more emphasis to quality improvement and recognise that there’s a limited role for inspection,” he said.

“But equally there are other senior people in CQC who are much more positive about what inspection has achieved and what it can achieve in future.”

Professor Ham admitted he did not have “much hope” that national bodies would reduce the burden of performance management in the short term because the next year was “going to be about grip”.

“I think the centre in many respects has reduced local autonomy both of foundation trusts and of commissioners too,” he added.

“If you look at the planning guidance and the letters that came out from NHS Improvement and CQC in January… this is all about the rising levels of anxiety among national bodies, in the DH, in the Treasury, about declining NHS performance on money and targets and a belief that only by strengthening grip will that issue be resolved.”