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The London Quality Standards: A case study in changing clinical care

This report evaluates the introduction of standards to improve acute and emergency care in London hospitals.

From 2011, the NHS in London embarked on a major programme to improve care for patients in emergency and acute services by introducing a set of professional standards. The London Quality Standards set out a range of minimum requirements, including regular consultant review during out-of-hours and at the weekends. Several formed the basis for the Seven Day Services Standards which the NHS is now committed to rolling out across England.

Our evaluation draws on surveys and interviews with those responsible for developing the standards and the frontline staff responsible for making them a reality. We found that the introduction of the LQS worked well in making people aware of shortcomings in care, and drove real change in how people worked. Our initial statistical analysis did not show any evidence that they achieved consistent improvement in patient outcomes.

The most important factor in making the standards a reality was a bottom-up effort from clinicians. We saw some deficiencies in hospitals’ ability to manage complex changes, and evidence of a deep disconnect between frontline staff and top managers. The use of reconfiguration as a “stick” to drive the standards demotivated staff, and eventually came to be seen as an empty threat.

Suggested citation

Vaughan L, Machaqueiro S, Gaskins M and Imison C (2017) The London Quality Standards: A case study in changing clinical care. Nuffield Trust.