England's Quality Strategy: How can we use this to accelerate improvement in health and care?

The Quality Strategy for NHS-funded care in England is here, along with a suite of supporting documents, including a technical annex of quality metrics and a Quality Management Systems (QMS) practical guide expected soon. 

The Quality Strategy sets out the ambition to achieve sustained measurable improvement in the quality of NHS-funded care, supporting the three shifts outlined in the 10 Year Health Plan for England. 

It aims to be a ​‘coherent framework for action’ that makes quality the ​‘organising principle’ of the NHS. 

It sets out 10 enablers. These include: 

• clarifying accountabilities for quality
• aligning incentives and rewards for high quality care 
• increasing transparency for the public on care quality

Additionally, QMS are identified as the means by which ​“local organisations apply [the strategic enablers] in practice.” 

In parallel, NHS England (NHSE) are publishing a number of Modern Service Frameworks (MSFs) that set out to standardise care and quality in specific health conditions. The idea is that they will enable the adoption and spread of best practice. The recent cardiovascular disease (CVD) MSF was the first to be published. 

Q members who are also NHS Alliance members can access their summary and analysis of the Quality Strategy.

Quality is integral to what we do (the Q in the Q community stands for quality!), so we’ve been influencing this strategy throughout its extended development. 

• In May 2025 we hosted a roundtable with NHSE and a cross-section of Q members, ensuring a place for your voice to be heard by those writing the Quality Strategy. We published the recommendations which emerged from the roundtable on our website. These particularly included the need to embed patient voices in work to improve care, and ensuring that the strategy sets out to support investments in QMS capability development. 
   
• Our Managing Director, Penny Pereira, was part of the Quality Strategy Reference Group. We’ve also been supporting the NHSE teams behind the scenes, for example with their QMS practical guide which will be published following the strategy soon. Penny and colleagues also published a blog about the Dash review recommendations, which was based on learning from the Q community. We raised these with NHSE through the reference group. 
   
• We identified the need for effective data and learning infrastructure to improve quality. We are pleased to see our influence reflected in the proposals relating to the review of metrics. To be successful, this work needs to pay attention to the human as well as the technical dimensions of measurement and wider infrastructure for learning.  
   
• Our most recent series of National Improvement Leaders’ peer spaces focused on QMS (and will do so again in 2026/27). This provides an opportunity for policy leads to learn from each other and explore together what will deliver the greatest impact at national level. 

We will continue to share learning from the evidence and our community to inform the Quality Strategy as it moves to implementation. 

Now that the strategy is here, what does it mean for accelerating improvement locally? We highlight three areas of opportunity below. 

The strategy provides an opportunity to engage boards with your improvement work given their clearer responsibility for quality. Positioning quality improvement as part of a QMS may be particularly helpful, given the policy direction. 

We know many organisations will be at an early stage of their QMS journey and may benefit from help understanding what this could mean for them:

• We’ve a range of resources which can help you with this and have collated them lower down this page. 
• We also offer practical, evidence‑informed support to organisations, tailored to your local context. Find out more about our support for developing and embedding QMS in the link below or email q@thenhsalliance.org .

The quality strategy reinforces the Darzi definition of quality: safe, effective and with positive patient experience. This is a good time to raise the profile of these three areas and the contribution of improvement. 

Following publication of the Dash review, there was some sense that safety had become too significant a focus of investment. The Quality Strategy identifies safety as the foundation for quality – and this is a good time to both reassert its importance, while promoting a holistic approach where improvement work benefits all domains. 

There are also 48 references to ​‘value’ in the strategy and significant emphasis on making best use of resources. The publication of this strategy is therefore an opportunity for members to reinforce the importance of improvement approaches that reduce waste in ways that benefit all quality domains. 

A newly formed National Quality Board is set to help filter and prioritise all the numerous recommendations from policy and inquiries. It will also develop a set of metrics that can be used by organisations.  

While it may take some time for this to be felt locally, this emphasis in policy could be an opportunity to review and further focus what you’re doing and measuring. 

While it’s easier to define and measure accountabilities and interventions within organisations, we know many quality challenges occur at the transitions between services. So whole pathway approaches should remain central. 

The strategy proposes enhancing the role of System Quality Groups. In the context of significant changes and pressures on ICBs, making sure these add value may rely on the input and influence of local leaders committed to collaborative improvement. 

Tools like our cross-system improvement framework or our skills for collaborative change may help you when working across boundaries.

In this special episode of Leading Improvement in Health and care, Penny Pereira speaks with Professor Frankie Swords, National Medical Director for NHS England and the Department of Health and Social Care, and Sarah Barley-McMullen, strategic lived experience partner for NHS England and Chair of Long Covid SOS.

They explore why quality must become the NHS’s guiding principle, encompassing safe and clinically effective care as well as a positive patient experience. The conversation considers the role of leadership and organisational culture, the use of meaningful data and shared metrics, reducing unwarranted variation, and making it easier for people throughout the health and care system to do the right thing.

Tell us what you think about the Quality Strategy. We’ll be publishing a piece about member reactions soon, so please let us know what this strategy means for you? Email us at q@thenhsalliance.org

Our website includes a wide range of examples and resources that can help support local system improvement – we’d love to hear where you’d like us to expand further.