National support to improve quality of healthcare services and outcomes for the population
Maria Roberts, Head of Quality Assurance and Clinical Effectiveness, Cardiff and Vale University Health Board
Introduction
The Quality and Engagement Act 2020, became statutory in April 2023 and aims to enhance healthcare quality and outcomes in a post-COVID, financially challenging era. Co-produced statutory guidance was developed with NHS organisations and stakeholders, leading to a roadmap for NHS actions. The Welsh Government sought regular updates on roadmap progress, revealing a need for support in understanding quality obligations.
The national Quality and Safety Programme was tasked with aiding NHS Wales in embedding the duty. NHS organisations self-assessed their progress against milestones in themes such as quality standards, management, decision-making, reporting, commissioning, hosting, training, communication, leadership, and governance, with most at the "Planning and resourcing" stage.
Methods
The programme focused on four key components for a holistic, whole-system approach: embedding Health and Care Quality Standards, developing a Quality Management System, quality-driven decision-making, and quality reporting.
A SharePoint site with practical tools and resources was developed with stakeholder input. Agile project management was used, involving planning, designing, developing, testing, deploying, and reviewing phases to support flexible and collaborative work.
After reviewing existing Quality Impact Assessment practices and tools, the Programme developed and tested an all-Wales QIA tool, making iterative improvements based on feedback.
Outcomes / Learnings
- The Programme successfully translated quality policy into practice with supporting resources for NHS Wales within one year.
- Positive professional relationships were quickly formed within NHS organisations.
- Disciplined project management and good documentation were maintained.
- Influenced and nurtured work across the healthcare system, creating a "golden thread" of quality.
- Colleagues appreciated tangible, consistent messages during duty implementation.
- NHS organisations valued contributing to the transition from policy to practice.
- Challenges arose during a time of significant change, including the launch of NHS Wales Executive.
- Limited capacity for true co-production from NHS organisations despite their enthusiasm.
- Survey feedback from eight organisations was positive about Programme preparation for the duty.
What next?
- Task and finish work has concluded but additional opportunities identified for consideration by the Quality, Safety and Improvement directorate.
- Performance and Assurance will revise the roadmap for a ‘deep dive’ review of the duty’s implementation after one year.
- Welsh Government will evaluate the Act, with the Programme contributing to the initial phase.
- NHS bodies and Welsh Government must prepare annual quality reports.
