An imbalance towards control

If you looked at national initiatives in the NHS in England over recent years you would see a big imbalance in strategy towards control and away from improvement and planning, Dr. Jennifer Dixon, Chief Executive, Health Foundation UK, told the Conference.

Dr Jennifer Dixon
Dr Jennifer Dixon

Health Foundation UK is an independent charity committed to bringing about better health and health care for people in the UK.

Dr. Dixon, who spoke on “Driving Quality Improvement in the NHS,” said there had been a strong emphasis on regulation and on payment reform, but less attention to providing support to providers to make changes at the front line. Quality improvement was what happened in front line care.

There had been an impressive array of initiatives, but they did not always cohere together and often you couldn’t see the wood from the trees.

“We haven’t been so good at assessing the evidence of some of our quality improvement initiatives and we haven’t devoted ourselves to achieving improvement each day.”

The overall effect was that planning and improvement functions were underdeveloped and core functions were unbalanced.

Dr. Dixon said improving quality remained a stated priority, but implementation was weak. Following the second Francis Inquiry, strengthening control functions became an understandable and necessary priority, but there had not been a concomitant effort devoted to strengthening planning and improvement. The overall effect was that planning and improvement functions were underdeveloped and core functions were unbalanced.

There was also a lot of emphasis on trying to shift care from expensive hospital care to cheaper primary care. In the NHS last year 75 per cent of hospital providers ended in the red, to the tune of £2.5 billion.

Efficiency had to be increased if the services were to squeeze into the fiscal envelope. Quality in the NHS was improving, but the spectrum of Mid Staff was still hanging over the service and the question was how could a Mid Staff type situation be averted and the quality of clinical care be improved in this fiscal environment.

Against this background, The Health Foundation UK recently looked at overall strategies for improving healthcare in England and published a report which set out a practical and feasible set of actions for a strategy to implement the shared vision in Forward View – which charts a five year plan for the NHS.

These concepts were used throughout the report to identify the relative strengths and weaknesses of the NHS, as well as to identify potential gaps and duplication.

Forward View highlighted ‘closing the care and quality gap’ as one of three strategic challenges facing the health service in England by 2020.

Dr. Dixon said The UK Foundation report “A clear road ahead – Creating A Coherent Quality Strategy For The English NHS,” provided a set of benchmarks against which they compared the NHS to guide the Foundation in the analysis of recent initiatives and approaches to improving quality. These concepts were used throughout the report to identify the relative strengths and weaknesses of the NHS, as well as to identify potential gaps and duplication.

‘A Clear Road Ahead’ considered how policymakers – the government and the main arm’s length bodies – could most effectively support the people and organisations actively engaged in delivering health care services to achieve high quality care for all within available resources.

It assessed the recent array of organisations, initiatives and approaches to improve quality in the NHS and ask how they stacked up as an emergent strategy.

Since 2004, the Health Foundation has:

  • Invested over £120 million in the frontline NHS in the UK.
  • Funded 320 clinical teams to test new ideas in the NHS.
  • Invested in 370 fellows in leadership and quality improvement.
  • Funded and evaluated practical change programmes in Patient Safety, Person-Centred Care and Flow.
  • Funded 148 NHS Trusts and 780 General Practices in England.
  • Influenced clinical guidelines and practice, and national policy.