Quality improvement - other support
Policy and reports
This section includes key strategic and standard documents which shape the current policy framework for clinical governance. The items below are specific to quality improvement.
The national standards and strategies set out the overarching quality agendas - please refer to the four country overviews: England, Northern Ireland, Scotland and Wales.
For related guidance see quality improvement - guidance and tools.
The documents below are listed in date order. The most recent publications appear at the top of the list.
Some of the resources below may be in PDF format - see how to access PDF files.
Nursing Care Quality Forum
This new forum was announced by the Government in England in January 2012. It was set up with the aim of improving the quality of nursing care across all care settings. It will begin its work by identifying and supporting the spread and adoption of best practice across four areas: how to promote and achieve accountable and empowered nurse leadership across the system; how to make sure that the right culture and the right values that put patients first prevails at all times; how best to involve, listen to, hear and respond to feedback from patients and how to make sure that those providing care have the time to do so properly.
Nursing and Care Quality Forum mission statement (PDF 18.7KB).
The first meeting of the Forum was held on 17 April 2012 and the RCN attended this first meeting.
QIPP - Quality, Innovation, Productivity and Prevention
This is a large scale transformational programme for the NHS in England. It aims to "improve the quality of care the NHS delivers while making up to £20billion of efficiency savings by 2014-15, which will be reinvested in frontline care".
An RCN policy briefing on QIPP, published in 2012, provides details of the programme and "asks for more transparency so that the public, patients and staff can know what QIPP means for them, and to reassure them that it is not just focusing on short terms cuts but will deliver against all four of the areas covered in the QIPP title" see Quality Innovation Productivity and Prevention (QIPP) in England (PDF 174.1KB).
NHS Outcomes Framework 2012-2013
The NHS Outcomes Framework, published by the Department of Health, places a focus on improving outcomes for patients and describes this as the primary purpose of the NHS. “The framework sets direction of travel in the journey towards improving outcomes, and offers an opportunity for the NHS to begin to understand what an NHS focussed on outcomes means for individuals, organisations and health economies”. It is structured around five domains which set out the high-level national outcomes that the NHS should be aiming to improve. These were derived from the definition of quality first set out by Lord Darzi in the NHS Next Stage Review which has three main elements – quality of patient experience, effectiveness of care and patient safety. It is also underpinned by the need to promote equality and reduce inequalities in health outcomes. A public health outcomes framework and adult social care framework will also be developed to support integrated care.
Indicators that best measure the outcomes are set out in the framework which will be refined on an annual basis to ensure that appropriate outcomes and accompanying indicators are being used, but there is also recognition that continuity of indicators is important if progress is to be measured. This is the current version of the framework. For the first version published in 2010 see NHS Outcomes Framework.
Department of Health: National Quality Board
This section of the Department of Health website is about the work of the National Quality Board (NQB) which is a multi-stakeholder board established to champion quality and ensure alignment in quality throughout the NHS. The Board is a key aspect of the work to deliver high quality care for patients. The first report of a two-phase review, published in October 2011, describes the key roles and responsibilities of organisations and individuals that will protect and improve quality and suggests practical steps to safeguard quality during the changes to be made by the Coalition Government and through the Health and Social Care Bill – see National Quality Board advice and recommendations.
For further details of the Health and Social Care Bill see England: national standards and strategies.
ISD Scotland: Quality Improvement Programme
The aim of the Quality Improvement Programme in ISD is to improve health care by operating as the centre of expertise for a range of information services supporting quality improvement. The NHS Scotland Healthcare Quality Strategy published in 2010 determines the strategic direction. The new developments page within ISD Scotland describes some of the new programmes and approaches, most of which are determined by the strategy. The Quality Hub supports the implementation of the strategy.
For further details of NHS Scotland Healthcare Quality Strategy see Scotland: national standards and strategies.
Department of Health: High Quality Care for All (2008)
This section of the Department of Health website is dedicated to Lord Darzi's final report of the NHS Next Stage Review which sets the quality agenda for the NHS. As well as the report itself and the 'Visions for better healthcare' that informed it, there is information about the National Quality Board "a multi-stakeholder board established to champion quality and ensure alignment in quality throughout the NHS". Other pages provide information on initiatives and activities that follow-on from the report including pages on innovation, quality accounts and measuring for quality improvement.
Leading better care: report of the Senior Charge Nurse Review and Clinical Quality Indicators Project (2008)
The second part of this report describes the Clinical Quality Indicators (CQI) Project in Scotland which is working in tandem with the Senior Charge Nurse Review reported in the first part of the report. A key aim of the project was to deliver robust quality indicators to demonstrate the nursing and midwifery contribution to care. The report presents a model for development of CQI's and their continuous review. The initial focus is on the development of four generic indicators applicable across a wide variety of patient settings: food, fluid and nutrition; falls; pressure ulcer prevention; monitoring and observation. The report contains an action plan for the implementation of both projects.
The quest for quality in the NHS: refining the NHS reforms - a policy analysis and chartbook (2008)
This report from the Nuffield Trust, one of the leading independent health policy charitable trusts in the UK, is the last in a series commissioned to analyse in depth the progress of and quality of care in the NHS in England over a 10 year period from 1997. It considers the extent to which improvements in quality are due to investment and effort made through reforms to improve the quality of care or whether due to other factors such as advances in medical knowledge or developments in healthcare delivery generally. The report suggests that the reforms are insufficiently integrated and calls for the establishment of an English national quality programme.
Improving quality and safety - Progress in implementing clinical governance in primary care: lessons for the new Primary Care Trusts (2007)
The National Audit Office (NAO) reviewed the progress made by primary care trusts (PCTs) in establishing implementing clinical governance basing their assessment on nine key components. The review was undertaken between October 2005 and January 2006 and highlights the positive impact of clinical governance on the quality of patient care. The report, made available on the NAO website, presents findings in three main sections: the structures and processes for effective clinical governance that are in place; variations in progress made in implementing clinical governance; how aspects of patient and public involvement and the patient experience can be strengthened. Lessons drawn from this review have informed an accompanying document which provides key questions which Chief Executives and boards can focus on to progress implementation of clinical governance in the new PCTs.
Learning from tragedy keeping patients safe: overview of the Government's action programme in response to the recommendations of the Shipman Inquiry (2007)
This report, published by the Department of Health, outlines the Shipman Inquiry, the main themes of the Inquiry's reports and the developments in clinical governance, patient safety, and regulation since Shipman's day. The report describes how the recommendations of the Inquiry will be taken forward. In particular the actions outlined in response to the Inquiry's fifth report on regulation of doctors combine with the recommendations of the White Paper on regulation of health professions 'Trust, Assurance and Safety: the Regulation of Health Professionals in the 21st Century', to form a single programme of action.
Safeguarding patients. The Government's response to the recommendations of the Shipman Inquiry's fifth report and to the recommendations of the Ayling, Neale and Kerr/Haslam Inquiries (2007)
This report from the Department of Health brings together the common threads identified by the four inquiries and combines with the changes in the regulation of healthcare professionals presented in 'Trust, Assurance and Safety: the Regulation of Health Professionals in the 21st Century' to form a single programme of action to ensure patient safety.
It describes ways in which existing safeguards and clinical governance processes need to be strengthened and extended, taking into consideration the developments which have already been implemented in assuring quality, promoting patient and public involvement, and patient safety. Specific areas highlighted are recruitment and screening processes, better use of complaints from patients and their representatives and concerns from fellow professionals, and some of the current and future developments around this are described. A further issue is the key role of information in identifying potential problems of professional behaviour and competence and how this information is managed.
Safety first: a report for patients, clinicians and healthcare managers (2006)
This report from the Department of Health addresses the recommendations made by the National Audit Office (NAO) in its report 'A safer place for patients: learning to improve patient safety' (2005) - in particular around enhancing the development of effective safety cultures and improving the sharing of learning from patient safety incidents and the dissemination of learning from the National Reporting and Learning System (NRLS).
'Safety first' describes landmark reports in the development of patient safety policies. It makes a series of recommendations which include: the improvement of the NRLS to simplify reporting of adverse events; the establishment of a National Patient Safety Forum and Patient Safety Action Teams; and the better engagement of patients and families in patient safety issues.
Bristol Royal Infirmary Inquiry (2001)
The Bristol Royal infirmary inquiry was one of the most searching investigations into the National Health Service ever undertaken. The publication of the final report ("Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984 -1995") marked a watershed in NHS history and its recommendations had a profound effect on NHS reforms.
This website brings together many of the documents submitted during the course of the investigation, including seminars and transcripts. The Inquiry was set up in 1998 to investigate the deaths of 29 babies undergoing heart surgery at the Bristol Royal infirmary in the late 1980s and early 1990s. However the Inquiry ultimately addressed fundamental issues of clinical safety and accountability, the culture of professional groups in the health service, and the rights of patients.
Organisation with a memory: report of an expert group on learning from adverse events in the NHS (2000)
This seminal report, published by the Department of Health, examined the key factors contributing to organisational failure and the steps required to create a culture of learning in the NHS. The expert group presented evidence about the status of patient safety in the health service and reviewed the potential of other strategies from high risk organisations. The report made recommendations to address the negative effects of a prevailing blame culture and poor understanding of error in healthcare. These included a proposal for the creation of a new national system for reporting and analysing patient incidents.