News / King’s Fund: quality not finance should be guiding strategy for English NHS

Writing alongside a new report on quality management, King’s Fund chief executive Chris Ham said: ‘Quality not finance should be the guiding strategy of the English NHS.’

NHS Improvement and the Care Quality Commission have recently called on providers to consider quality and finance equally in planning decisions. And the King’s Fund highlighted the risk that quality of care could be seen ‘as a lower priority until finances have been stabilised’.

However, defining quality improvement as ‘designing work processes and systems that deliver…better outcomes and lower cost, wherever this can be achieved’, the think tank called for improved financial performance to be ‘framed as a mission to deliver better value’. This was the only way to engage staff, it said.

‘While the NHS needs to live within its means, bringing spending into line with available funding needs to be done in a way that promotes quality improvement rather than making it more difficult,’ the report said.

Professor Ham (right) pointed to recent encouragement from national bodies for providers to use all means at their disposal to reduce deficits, including reviewing headcount.

‘There is little recognition that improved financial performance can be a consequence of improvements in quality, nor that changes in clinical care should be a key focus,’ he said.

While the NHS had pursued quality improvement in fits and starts, a ‘coherent and integrated’ approach would draw lessons from the past and from organisations and systems in the UK and around the world.

The report stressed the importance of clarity about the role of inspection. ‘Inspection, done well, has a part to play in quality assurance, but this should not be confused with quality improvement,’ it said. The authors claimed the failure to understand this had led to a ‘relative neglect of quality improvement and unrealistic expectations of what inspection can achieve’.

John Graham (right), director of finance at the Royal Liverpool and Broadgreen University Hospitals NHS Trust and chair of the HFMA Costing for Value Institute, said there were increasing examples of where improved quality and better outcomes led to a reduction in costs. ‘We don’t always have the capacity to deliver this improvement in-house and we need to get better at sharing examples of these win-wins,’ he said.

The report was clear that progress would not be achieved overnight. ‘As difficult as a quality improvement strategy is, and as long as it may take to harvest the changes at full scale, we simply do not see a more promising alternative,’ it said.

Quality improvement strategy

1. Enable NHS organisations to build in-house capacity for quality improvement
2. Support NHS organisations through shared learning and regional support
3. Establish a modestly sized national centre of expertise
4. Integrate work on quality improvement with work on leadership development
5. Ensure national bodies provide unified, co-ordinated support to the NHS as full participants in a single strategy
6. Involve frontline clinical leaders and leaders of NHS bodies in developing strategy
7. Commit to involving patients and public in designing and implementing the strategy
8. Be open to learning from other organisations at home and abroad
9. Work with other organisations and experts outside the formal structures of the NHS
10. Reflect, measure and learn rapidly about what does and doesn’t work.