The quality of NHS care has been scrutinised in the past year probably more than in any other since its birth. We are contributing to this debate by launching QualityWatch – a programme to look at how quality of care in England is changing.
The past two years have seen a series of reports detailing high-profile failures of care or concerns about other potential ones. It is clear that assessing quality is of increasing importance to an increasing number of organisations, both national and local.
These failings are of course important, but they do not necessarily equate to a complete picture of quality. They do not tell us how widespread failings are – or alternatively where services have improved.
In fact the quality of care is a notoriously difficult thing to assess. It is complex to define, and hard to measure or assess in ways that are rigorous and consistent.
Though our ability to use information is improving all the time, there are serious limitations in the data available and indicators can often give conflicting messages which can take some untangling.
Quality of care is a notoriously difficult thing to assess
The QualityWatch programme therefore aims to improve our understanding of what is happening to quality and in particular how quality is changing over time.
Our approach, which is intended to complement other national initiatives, is based on:
- Using indicators (both existing ones and new ones we are developing) to measure changes in the quality of care. These will be used to track change over time. Where possible we will look across areas within England and in comparison with other countries.
- Deeper analyses on specific topics. We want to be flexible in the methods we use and the topics we look at – as well as build on the Nuffield Trust’s capacity to use complex information.
These topics allow us to identify target areas that are potentially important and which would benefit from more detailed quantitative and qualitative analysis. So for example, amongst our current topics are: work on trends in outcomes from hip fractures; patterns of anti-depressant prescribing in primary care; and the impact of budget cuts in social care.
There are of course many people involved in monitoring quality – but we think there is room for external independent scrutiny by organisations outside the statutory health and social care system, which can take an overall, comprehensive view, not bound by specific responsibilities.
We hope our work will both augment and inform other statutory national initiatives. Moreover we are not trying to produce a repository of the latest data – there are others better suited to that task.
But we do want to produce analyses that consider broader changes over longer timescales and across sectors and domains of care. We believe such an overview is vital if we are to navigate through the coming years of financial constraints without sacrificing the quality of the care delivered.
Both the Nuffield Trust and the Health Foundation have a history of working in this area, in particular the Quest for quality work led by Sheila Leatherman – now a Trustee of the Nuffield Trust and Chair of the QualityWatch advisory group.
The programme is launching with a range of products including a dedicated website looking at selected quality indicators and how they are changing, as well as more detailed reports in specific areas.
These are just the start and we have a further programme to extend this work. We regard the work of the first year as the start of a longer journey in which we want to work with various groups to improve our understanding of quality beyond short term headlines.
We welcome your thoughts, comments and advice as this work develops.