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

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 …