Action on quality improvement can’t wait

The Quality Strategy for NHS-funded care in England makes quality a system-wide responsibility and positions a Quality Management System approach as the foundation for sustainable improvement. The Q community and its members can help turn this ambition into action by building improvement capability, enabling peer learning and supporting implementation of the NHS Quality Strategy in local health systems. 

The 2026 Quality Strategy for NHS-funded care in England represents the most significant reframing of quality in the NHS since the publication of the 2008 High Quality Care for All review. It positions quality as the organising principle of the NHS, recognising it not only as a driver of safety, effectiveness and equity, but also as a core function across governance, assurance and regulation. 

Too often, quality has been viewed through a siloed lens within the purview of specialist individuals and teams. The explicit recognition is that quality is a system responsibility, with accountability across system organisations and boards, who all have a role to play in creating the conditions for improvement. This shift in worldview creates a stronger line of sight between strategic intent and operational delivery. 

The challenge now is moving from aspiration to action. 

The introduction of Quality Management Systems (QMS) as the mechanism for bringing together quality planning, control, improvement and assurance can help organisations to apply a structured approach to quality and is supported by the recent publication of  QMS implementation guidance.  

Many organisations undertake excellent quality improvement projects but struggle to sustain changes because improvement activity is not integrated with operational management, assurance and governance. 

The Quality Strategy correctly identifies that improvement alone does not constitute quality management. 

Sustainable improvement requires a whole systems approach that aligns planning, governance, measurement and operational control. These activities have often operated in parallel, rather than part of a coherent whole. 

A mature and developed QMS creates the conditions needed to sustain continuous improvement over time. It provides clarity about roles, responsibilities and resources to ensure that the impact and learnings of quality improvement have the appropriate accountability and governance. 

The recent publication of Implementing quality management systems in the NHS  provides a national framework for a consistent approach to quality management, with implementation guidance that can be tailored locally. 

Another key message in the strategy is that value should not be confused with cost reduction. Value is defined as achieving the greatest possible improvement in outcomes, experience and equity from the resources available. For patients, value often means: 

• Receiving the right care at the right time 
• Being involved in decisions 
• Experiencing seamless care across organisational boundaries 

The strategy has a strong emphasis on patient experience and feedback, recognising the value of both quantitative and qualitative data for driving improvement. 

Embedding the patient voice through initiatives such as Martha’s Rule, patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs) and access to Federated Data Platform tools, reflects this commitment and ensures that care is shaped around patient needs, experiences and outcomes. 

A key barrier to turning the strategy into meaningful change is workforce capacity and leadership capability. The strategy provides scant details on how organisations can create the capacity to deliver quality improvement sustainably. 

Many NHS organisations are operating in an environment characterised by significant workforce pressures, financial constraints and increasing demand. Asking leaders and teams to adopt new ways of working without providing the necessary support will limit the impact of the strategy. 

Implementing QMS requires more than new governance or reporting arrangements. It requires leaders and managers to understand how quality management supports strategic decision making and also provide frontline staff the confidence to test, adapt and spread new approaches. The strategy’s emphasis on predictive analytics, real intelligence and Federated Data Platform capability, that uses data for improvement rather than retrospective assurance, is a major cultural shift, given the varying data maturity of NHS organisations. 

The Q community is uniquely positioned to help and support the NHS and its members with the implementation of the Quality Strategy as it operates as a leader across organisational and professional boundaries. 

The strategy repeatedly highlights the importance of sharing, learning and collaborating across complex systems. These are areas where Q has developed considerable expertise, with its strength lying not in developing top-down solutions, but rather creating the conditions for learning and improvement to flourish. 

This boundary leadership allows it to facilitate collaboration, learning and innovation to develop shared quality improvement capability across systems. 

Q can support implementation in three particular important ways. 

1. First, it can build capability by helping members develop practical skills in quality management, improvement science, measurement, co-production and systems thinking. 
2. Second, it can enable peer learning by connecting people facing similar challenges and facilitating the exchange of experiences, insights and solutions. Organisations are often more likely to adopt and adapt approaches that have been tested successfully by their peers. 
3. Third, it can bridge the gap between policy and practice. National strategies provide direction and ambition, but implementation happens locally. Q is uniquely positioned to help translate strategic intent into practical action by creating opportunities for experimentation, reflection and shared learning. 

Can the quality strategy drive meaningful change and accelerate improvement locally? 

The National Quality Strategy arrives at a time when the health and care system faces immense workforce, operational and financial pressures. By positioning quality as the organising principle of the NHS and identifying Quality Management Systems as the mechanism for delivery, the strategy provides a coherent framework for improving outcomes for patients and populations. 

Its success will depend on how NHS organisations shift from isolated improvement projects and assurance to integrated Quality Management Systems. These must systematically plan, control and assure value and quality improvement across the domains of effectiveness, experience and equity. 

Action on quality improvement can’t be delayed. The focus of leaders now must be on implementation to develop learning networks and supporting collaboration on quality improvement across health and care systems. This is arguably one of the most important organisational development agendas of the next decade.