Recommendations for the quality strategy: how Quality Management Systems can deliver the NHS’s quality ambitions

Penny Dash’s review of patient safety heralds a turning point for the NHS. The message in the Dash review and the NHS 10-year health plan for England is clear: the NHS has lost its way on quality. 

The Dash review concludes firmly that ​‘too many functions sit outside… providers of care who are ultimately responsible for improving quality (including safety)’. In turn, Dash recommends that provider organisations:

• streamline and consolidate quality functions
• strengthen governance and accountability for quality, including building skills and capabilities
• better utilise data and technology for insight and improvement
• more fully embed patient voice.

The review also identifies four main areas required to ensure a high-quality health and care system: developing a strategy, delivering health and care, assuring delivery and improving. These directly align with the components of a Quality Management System (QMS): quality planning, control, assurance and improvement. The review also explicitly recommends that providers ​‘operate effective quality… management systems’. 

On the back of Dash’s recommendations, the National Quality Board will set out expectations for providers in a quality strategy, due by March 2026. Drawing on our work on QMS and insights from a May 2025 roundtable we convened with NHS England, we offer key recommendations for how the quality strategy can best meet the needs of the health sector.

The Dash review highlights the fragmentation and duplication of quality functions across the NHS. It calls for reinforced responsibility and accountability of providers and commissioners to deliver and assure all aspects of quality. 

Well-developed QMS can support these ambitions by integrating quality management and safety management – alongside effectiveness, patient or user experience, accessibility, equity and efficiency – into a coherent system. This would streamline work and improve how the quality functions work together.

Dash specifically asks that quality management includes ​‘efficiency or use of resources and people management’. Our case studies show how organisations are exploring the potential for QMS to achieve this through empowering staff to drive continuous improvement while balancing quality, cost and sustainability. In the case study organisations, this led to measurable improvements, such as reduced surgery cancellations and better medicine recycling. 

The quality strategy should recognise that currently, whole-organisation QMS are not the dominant approach in the NHS. The strategy will need to proactively engage all relevant functions and professions – safety, operations, finance and beyond – which too often work in silos. In particular, leadership must set the vision, direction and culture, connecting strategy to everyday work. 

Both the 10-year plan and the Dash review emphasise the need to better use data, including to maximise the potential of artificial intelligence (AI). Dash notes that currently, ​‘insufficient use is made of the NHS’s data resources to generate insights and support improvement’. 

QMS place data and learning at the heart of quality management. They enable organisations to understand population needs, monitor performance, track improvement, assure quality and better connect data to action. 

To best use data, the quality strategy should emphasise the importance of both technical and human infrastructure — that is, ensuring people have the skills to interpret and act on data alongside a culture and systems that support learning and improvement. Investment in the human infrastructure needs to keep pace with what’s possible through tech and advancements in AI. 

Aneurin Bevan University Health Board​’s work developing an integrated QMS shows the potential to achieve this. Their approach helped use data to draw links between finance, performance and quality and better use information to target resources. 

There is growing recognition of the need to embed patient voices in work to improve care, evidenced by the strong emphasis on this in the 10-year plan. A well-developed QMS puts patients’ needs at its core — using them to guide quality planning, standards, audits and improvement. 

In the most developed QMS examples, such as East London Foundation NHS Trust, patients co-produce quality processes alongside staff. But across the NHS, meaningful involvement is still underdeveloped.

Given the changes to health and care structures, and widespread commentary on the risks of losing more holistic mechanisms for patient voice, the quality strategy should set clear expectations around including patient and public voice in quality management. It should also provide support for meaningful, embedded patient engagement, building on existing good practice.

To succeed, the quality strategy must set out a quality management approach that offers clear definitions and expectations. But this must allow flexibility for organisations to build on their existing strengths. As evidenced in our research, organisations’ starting points and journeys vary to fit different contexts and needs. An overly rigid and prescriptive one-size-fits-all approach risks alienating those already making progress. 

The balance between clear expectations and flexibility is especially important in areas where QMS are currently less developed, such as primary care and neighbourhood health. 

Finally, but importantly, the strategy should support investments in QMS capability development — including through practical tools, peer learning opportunities, sharing insights from other nations (eg Wales and Scotland) and learning from other sectors where QMS are more established. 

Q and others are already delivering and developing support offers for QMS. Progress is also being made on building the evidence base for QMS in health, which, although promising, remains at an early stage.

The Dash review and 10-year plan have laid out the challenges to improving quality. Careful consideration is now required of how their recommendations can be implemented.

A well-developed quality strategy — grounded in a QMS approach — can help. By integrating quality functions, strengthening data use, embedding patient voice, allowing flexibility and supporting capability development, the strategy can create the conditions for lasting change.