Table 1

Quality initiatives for the NHS in England introduced since 1997 (excluding documents relating to the development and regulation of the professions)

YearSourceType of documentTitleQuality initiatives
1997DoHWhite paper The new NHS: modern, dependable Describes a 10 year plan to improve the NHS, including the replacement of the internal market with a system of integrated care. NHS to be primary care led. Introduced national service frameworks, new organisational structures to promote evidence-based care and monitor standards (NICE and CHI), the policy of clinical governance and NHS Direct
1998NHSEConsultation document A first class service: quality in the new NHS Announced a three part approach:
• National standards to be set by National Service Frameworks and the National Institute for Clinical Excellence
• Dependable local delivery systems to be achieved through clinical governance, lifelong learning for NHS staff, and a system of self-regulation
• Monitoring by the Commission for Health Improvement, a national framework for performance assessment and an annual survey of patients' and users' experiences
Changes to be implemented through partnerships among government, NHS and related organisations and patients
1998DoHGreen paper Our healthier nation Key aims are to improve the health of the population as a whole by increasing the length of people's lives and number of years people live free from illness. Describes the “third way” between blaming individuals and nanny state social engineering. Third way is a contract whereby the government, local communities, and individuals join in partnership to improve health
1998DoH Working together: securing a quality workforce for the NHS A strategic approach to managing human resources in the NHS. Three aims:
• to ensure that we have a quality workforce, in the right numbers, with the right skills and diversity, organised in the right way, to deliver the government's service objectives for heath and social care;
• to demonstrate that we are improving the quality of working life for staff;
• to address the management capacity and capability required to deliver this agenda and the associated programme of change.
1999NHSEImplementation paper The NHS performance assessment framework Introduced a broader based approach to assessing performance in six areas:
• health improvement;
• fair access to services, irrespective of geography, socioeconomic group, ethnicity, age or sex;
• effective delivery of appropriate health care—care must be effective, appropriate and timely, and must comply with agreed standards;
• efficiency—to ensure that effective care is delivered and that the NHS achieves value for money;
• patient/carer experience—to assess the way people view their care to ensure the NHS is sensitive to individual needs;
• health outcomes—to assess the contribution of the NHS to the health of the population.
1999NHSE Improving quality and performance in the new NHS: NHS performance indicators First set of data on high level performance indicators and clinical indicators to enable health authorities, primary care groups, and NHS trusts to monitor and compare their performance
1999DoHImplementation paper Clinical governance: quality in the new NHS Sets out the arrangements for implementing clinical governance. Regulates NHS organisations to put in place:
• clear lines of accountability and responsibility for the quality of clinical care;
• a comprehensive programme of quality improvement activities;
• clear policies aimed at managing risk;
• procedures for all professional groups to identify and remedy poor performance
1999DoHWhite paper Saving lives: our healthier nation An action plan to tackle poor health. Focused attention on cancer, coronary heart disease and stroke, accidents, and mental illness, and set targets for reduction of incidence. Established the Health Development Agency and the Public Health Development Fund
2000DoHWhite paper The NHS plan: a plan for investment, a plan for reform • A modernisation board, 10 task forces and a performance working group to oversee, advise, and drive forward the implementation of the plan
• New incentives for better performance and reward schemes
• New modern and better equipped buildings
• More staff working in better conditions with opportunities for career development and advanced training
• New educational systems and expansion of medical students, nurses and other health professionals
• New structures for regulating health professions
• New ways of involving and representing patients views
• New strategy for public health and prevention of disease
• New technologies, such as Care Direct
2000DoHConsultation document A health service for all talents: developing the NHS workforce A review of the workforce and its educational requirements. Established a National Workforce Development Board
2000NHSE Improving quality and performance in the new NHS: NHS performance indicators Second set of data on performance