The Quality Agenda

Analysing Health Policy /

Contemporary Health Policy Analysis Kate Thomson

Session overview

• How has ‘quality’ been embedded in NHS reforms since 1997?▫ What mechanisms have been used to monitor

and improve quality?

▫ How has the quality agenda changed?

• Have quality mechanisms been effective?

• What is the meaning of quality?

• What other drivers for the NHS pose a challenge to the quality agenda?

Quality – from 1997

• NICE National Institute for (Health and) Clinical Excellence

• NSFs National Service Frameworks

• CHI Commission for Health Improvement (Healthcare Commission CQC). Centralised regulation, standardisation

Quality, performance & accountability

Quality issues – from 1997

• Regulation of medical profession

▫ Bristol case; Shipman

• Clinical governance

▫ Monitoring, audit, continuous improvement

• Central monitoring & inspection (CHI)

• Waiting lists

• Resources & financing

Quality

Access

Striking a balance in healthcare provision

Cost

What is the

relationship

between quality

and cost

/investment?

Performance & targets• ‘traffic lights’; star rating systems; health

checks• ‘earned autonomy’ & Foundation status• Increased number & coverage of targets, e.g.

waiting times▫ Increased central control – uniform standards from early 00s – less ‘control’

• QOF – quality outcomes framework in primary care

• Payment By Results + patient choice –incentivising quality?

Targets/ performance indicators:▫ Greener (2004): tightening of national

regulation frameworks betrayed a lack of trust in professionals to act in the best interests of the health service.

▫ Stevens (2003) (cited in Klein 2006): they ‘undermine intrinsic motivation and produce a compliance culture in which only what gets measured gets done’.

• Do you agree? • Coalition govt promised to eradicate ‘target-driven’ culture

Quality Domains (CQC)

• Safety

• Clinical and cost effectiveness

• Governance

• Patient focus

• Accessible and responsive care

• Care environments and amenities

• Public health

Current quality context: Darzi & beyond

• 2008 – Darzi High Quality Care for All

▫ Effectiveness

▫ Safety

▫ Experience

• NHS Constitution (2009)

• Coalition govt: Transparency in

Outcomes consultation NHS Outcomes

Framework 2011/12 (+ Public Health /

Adult Social Care frameworks)

•Increased cost pressures

•Shifting political landscape

World of acronyms:Do you know what these abbreviations

stand for?

If not, find out.

How does each relate to the quality agenda

/performance management?

From: DH (2010) The NHS Outcomes Framework 2011/12 (updated

frameworks & docs for each available via Moodle site).

Current quality emphasis

• Access to services▫ Primary care– times, availability▫ Drugs & treatments ▫ Closer to home / integrated care

• Patient safety▫ Infection control ; ‘never events’ ▫ Staffing levels

• Choice & empowerment• Value for money • Evidence & leadership

How is service user

choice (of

provider, of service

/treatment etc.)

related to quality?

Do you agree?