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Monday 26 September 2016
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Equity, liberty and the pursuit of quality

Someone once told me that everything happens for a reason – and frequently what first appears as coincidence in the NHS often has had reason behind it all along.

Take the white paper Equity and Excellence: Liberating the NHS. Many more politically astute commentators than me have made their views on the implications of this document very clear. But allow me to put the politics to one side for a moment to revisit some of the other "highlights":

  • Patients are to be placed centre stage – "no decision about me without me". Care is to be personalised, patients will be able to choose practices and be encouraged to rate healthcare services. A new, powerful, consumer champion, HealthWatch England, is to be established.
  • There is an explicit ambition to provide world-class outcomes based on quality standards.  Evidence-based outcome measures will be developed by NICE (around 150 of them) and targets with no clinical value will be removed.
  • Patient safety will be paramount.
  • Mortality and morbidity rates are to be reduced.
  • The introduction of an NHS Commissioning Board holding GP contracts and overseeing 500 GP consortia given massive budgets.

The last point, in particular, has been well documented by the media. As has the demise of SHAs and PCTs. Social enterprises are to be the new future.

We in Scotland will watch all of this unfold and develop with great interest, but we will also be busy with our own search for excellence. Next month heralds the launch of The Quality Strategy. This may not attract the same level of media interest, but there are plenty of similarities between this document and Equity and Excellence (aside from the commissioning aspect!).

The Strategy's purpose is to deliver the highest quality healthcare service to people in Scotland and to be recognised as among the best in the world. It has three main aims:

  • Putting people at the heart of the NHS.
  • Making it easier for NHS staff to do the right thing, every time.
  • Making improvements in areas that patients, their families and carers see as important.

These will be achieved by initiatives such as:

  • Incentivising quality.
  • Implementing a patient-safety programme.
  • Focusing on patients' rights, responsibilities and expectations.
  • Developing primary care performance management measures.
  • Overhauling enhanced services.

The document outlines three "Quality Ambitions" to support its main aims:

  • Partnerships between patients, families and healthcare staff. Demonstrating compassion, clear communication and shared decision-making.
  • Providing care from clean and safe environments, avoiding harm and/or injury.
  • Appropriate treatment at the right time. 

New government targets will be developed to support these Quality Ambitions.

How will this be measured? Well, as it was so successful in general practice, there will be a Quality Measurement Framework, much like the QOF. And just as there were patient surveys for practices, patients will be consulted on this too. Performance will be recorded and monitored on a Quality Scorecard.

Is it just chance that two different health services would come up with very comparable goals, measures, jargon and processes? Are these understandable coincidences, merely similar responses to similar challenges or well-planned overarching health strategies?

Whatever the truth, I firmly believe that many of these initiatives will improve services for patients. It will be fascinating to see how closely all four UK systems come to mirror one another, what the results of a Scottish election does to the mix and where we will all be a year from now.