Health Policy The National Health Service in England considers on the Government’s plans to improve quality of health care

The National Health Service in England considers on the Government's plans to improve quality of health care Commenting on another of its consultation papers, one notary recently gave the British Government " for presentation, minus for deliverability ". 1 Early indications are that the Government's consultation paper on quality in the English National Health Service (NHS) 2 could edge up to a plus or even an minus, with some more thought about the practicalities of implementation. The history of approaches to quality in the NHS has been of fragmented initiatives, with little sense of overall coherence. National complaints procedures resulting in pronouncements from the health service ombudsman, local consumer watchdogs, and external visiting bodies such as the Health Advisory Service have coexisted with variable internal and external use of voluntary performance indicators and patchy systems of medical audit. 3 The most systematic approach to a national quality programme came from the previous government, when they introduced the medical (later clinical) audit programme to the service at the same time as the " purchaser-provider split ". 4 This structural change was, itself, intended to produce improvements in quality, through the incentives anticipated by competition with other healthcare providers. Commitment to quality improvement was not always manifest in the priorities for performance monitoring, however, where measures—such as the eYciency index (essentially activity per £) and achievement of waiting list targets—overrode indicators of service quality. In its white paper setting out the dismantling of the former government's internal market in health care, the Labour Government signalled that fundamental changes to the approach to quality in the NHS were afoot. 5 A first class service: quality in the new NHS sets out their vision. The consultation paper introduces several measures which, taken together, are intended to produce a model of quality improvement which " marries clinical judgement with clear national standards " —that is, the Government is trying to harness national external approaches with local flexibility and responsibility. It proposes to achieve this by: x Setting national standards (through a National Institute for Clinical Excellence, (NICE) and national service frameworks for selected disease or client group areas) x Improving systems for local quality assurance and quality improvement (notably the new clinical governance proposals, but also including professional self regulation and lifelong learning) x Monitoring the implementation of standards (by a new national body, the Commission for Health Improvement, along with routine performance monitoring of …