Last week, NHS England published its review into delivery and continuous improvement, which explores how to enable the NHS to focus on delivering against its immediate priorities while continually improving services over the long term.
At the same time, NHS England launched NHS IMPACT – a national approach to improvement that will be used to support trusts to create the culture and conditions for continuous improvement within their organisations, allowing them to focus on the priorities that matter to their patients and staff, and deliver improvements in experience and outcomes.
I saw first-hand, as chief executive of Leeds Teaching Hospitals NHS Trust, the power of focusing on organisation-wide improvement over the long term. By implementing improvement methods and empowering staff and patients to co-produce our approach – The Leeds Improvement Method – we improved the quality of care, patient safety and patient experience. We also managed to recover financial and operational performance and boost staff experience. It was central to our way of working and a core part of my own leadership; I protected time to speak with new starters about The Leeds Improvement Method every week.
At NHS Providers, over the last two years, supported by the Health Foundation, we have been helping members to develop their understanding of improvement at scale through our Trust-wide Improvement Programme.
Chief Executive
These benefits weren't achieved overnight. They required focus from everyone in the organisation to create and sustain a culture of improvement and were helped by sustained investment.
Through NHS IMPACT, NHS England will ask trusts and systems to implement a systematic approach to continuous improvement, adhering to five components that align with evidence-based quality improvement methodologies, including building a shared purpose and vision around improvement, developing leadership behaviours to support it, building improvement capability, and embedding improvement into management systems and processes. NHS England will also work with trusts to focus improvement work on a small number of national priorities, to be agreed by a national improvement board.
At NHS Providers, over the last two years, supported by the Health Foundation, we have been helping members to develop their understanding of improvement at scale through our Trust-wide Improvement Programme.
Over 60% of our membership, 135 trusts, have taken part despite this being an intense period of change and operational pressures. This programme sought to join the dots around the role of improvement in helping members meet the challenges they face, placing quality front and centre and providing an alternative path to progress. We were delighted participants reported that our peer learning sessions helped increase their awareness and understanding of improvement at scale and increased their confidence in leading for improvement.
We are committed to supporting our members as they work to deliver in line with the NHS IMPACT approach to improvement.
Chief Executive
Many trusts expressed a hope for more consistency and clarity at national level about the role of improvement, with alignment of priorities across the system. The NHS IMPACT approach to improvement has the potential to meet this need. However, national leaders will need to take a 'problem framing' approach, as set out in the Virginia Mason Institute/NHS partnership evaluation, rather than defaulting to traditional forms of regulatory oversight.
Trusts have also been clear that with this clarity and alignment, they also require support. In particular, support to invest over multiple years given embedding improvement is a long-term endeavour, support to build improvement capacity and capability, and a realistic timeline for creating a culture of improvement.
We are committed to supporting our members as they work to deliver in line with the NHS IMPACT approach to improvement, and we will build on the experience of our Trust-wide Improvement Programme. We look forward to more detail from NHS England about what the NHS IMPACT improvement approach will mean in practice for trusts.
For trusts seeking to mature their improvement approach, we will soon be announcing details of three virtual peer learning events supported by the Health Foundation and working with Professor Nicola Burgess, who led the Virginia Mason Institute/NHS partnership evaluation. These events will focus on applying the learning from the partnership, with a focus on cultural readiness and the board's leadership role in improvement. You can express an interest by emailing us.
In the summer we are due to launch a new programme with the Q Community, focusing on supporting provider collaboratives to understand and explore how shared approaches to improvement, led by the board, are addressing operational challenges with an equity lens embedded from the outset.
We are pleased to see NHS England also commit to developing a leadership for improvement programme to support trust leaders to embed an improvement approach aligned with NHS IMPACT, as well as publishing several practical resources. Trusts will also need practical, ongoing support to implement the five components of the NHS IMPACT approach.
While improvement can provide benefits in terms of reducing waste, the level of pressure on trust finances nonetheless means this will be a very difficult ask.
Chief Executive
We know that not everyone is in the same place when it comes to improvement, with a growing number having built up considerable expertise and developed a supportive culture for improvement, while others are at earlier stages. Support should be tailored to the circumstances of individual organisations, so NHS England is right to recognise that there are opportunities to provide targeted support to trusts to develop their improvement approach.
Despite these important positives, there are elements currently missing from NHS England's offer. In particular, trusts will be asked to align with NHS IMPACT within their existing funding baselines. While improvement can provide benefits in terms of reducing waste, the level of pressure on trust finances nonetheless means this will be a very difficult ask.
Additionally, following through on the promises of this approach will require a change in mindset for many organisations and leaders. NHS England has recognised this need and has committed to better aligning its oversight with this new approach to improvement. But whether trusts will genuinely be given the time and space to focus on improvement, beyond meeting short-term operational and financial targets, is a question that remains to be answered.
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