Editorials

Quality to the fore in health policy—at last

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7151.95 (Published 11 July 1998) Cite this as: BMJ 1998;317:95

But the NHS mustn't encourage quality improvement with punitive approaches

  1. Richard Thomson (richard.thomson@newcastle.ac.uk), Senior lecturer in public health medicine
  1. Department of Epidemiology and Public Health, School of Health Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH

    News p 97

    In its own words, the consultation document on quality in the English NHS sets out a formidable agenda for change. Nevertheless, it constitutes a major advance, putting quality improvement at the heart of the service.1 The proposals describe a national approach that encompasses the National Institute of Clinical Excellence (NICE); the Commission for Health Improvement (CHIMP); national frameworks in key disease areas; the previously described performance management framework, with indicators relevant to NHS priorities; and a national patient survey. Locally, implementation and monitoring will be delivered through clinical governance, supported by national and local systems for lifelong learning, and reviewed systems of professional self regulation. Do all these elements add up to a coherent approach?

    The national institute will appraise evidence and develop and disseminate guidance and audit methods. It will coordinate or take over current activities such as guideline development and effectiveness bulletins. This is desperately needed because the plethora of guidelines—of variable quality and developed by multiple bodies—has created confusion in the service.2 But how will it deliver this huge agenda, apparently without additional resources? The original role of the Agency for Health Care Policy and Research in the United States was similar, but even with huge resources …

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