Time for a new approach to assessing the quality of hospitals in England

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4421 (Published 10 July 2013) Cite this as: BMJ 2013;347:f4421
  1. Nick Black, professor of health services research
  1. 1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  1. nick.black{at}lshtm.ac.uk

Managing quality is as important as financial management for trust boards

Politicians, clinicians, and the public are justified in questioning the ability and competence of the NHS to assess and monitor the quality of hospitals in England. Failures in managing quality have recently been reported at Stafford General, Furness General, and Tameside hospitals. Whatever the rights and wrongs of the claims and counterclaims about who was at fault, neither the mechanisms within the hospitals (clinical governance, trust board engagement) nor the external mechanisms for performance management (strategic health authorities until recently) and regulation (Care Quality Commission, professional regulators) have proved fit for purpose.1

Traditionally the NHS has assessed hospital quality in two ways: inspections and the use of statistical data. Each has its limitations. Although inspections helped to transform appalling conditions in nineteenth century workhouse infirmaries and, in the 1970s and 1980s, care in long stay institutions, their more recent impact is less clear.2 This reflects the shortcomings of inspections (such as the absence of experienced clinician inspectors, as occurred at Furness Hospital) and the failure of trust boards to act on the findings (as occurred at Mid Staffordshire NHS Foundation Trust).3

Meanwhile, statistical data have been …

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