Creating the conditions in which every organisation and system in the NHS has the leadership behaviours, culture, capability and capacity to deliver improved patient and staff outcomes

For all of my 21 years as a clinical leader, I’ve spent time trying to create the systems and galvanising colleagues to use improvement methodologies in order to improve outcomes for patients.

In April 2023, Amanda Pritchard, Chief Executive of NHS England, launched NHS IMPACT (Improving Patient Care Together) – the new single, shared approach to improvement. I am thrilled to be the Senior Responsible Officer for NHS IMPACT and I am passionate about driving this forward together.

The ambition for NHS IMPACT is for every organisation and system in the NHS to have the culture and tools in continuous improvement and to use them as the “go-to” for tackling unwarranted variation in operational, clinical and financial performance.


Because we know it works.

Organisations and systems that have a deeply embedded improvement approach have better patient and staff experience, less clinical variation, fewer health inequalities and better clinical outcomes. Providers that have achieved a CQC rating of outstanding have evidence of using a systematic approach to quality improvement.

And why now?

Because in our 75th year, our NHS is at a critical point in its history.

The British Social Attitudes Survey published in March 2023 showed that public satisfaction with the NHS now stands at 29%. This was at 60% prior to pandemic.

However, the public have also said that they are fundamentally committed to the core principles underpinning the NHS – that the NHS should be free of charge, available to everyone, and primarily funded through taxes.

So, it’s clear that we need to make urgent changes to provide more consistent, high-quality services for patients – to add years to their life and life to their years.

One of the things we are focussing on in NHS England is to support organisations and systems to have the leadership behaviours, capability and capacity to make these improvements happen.

Importantly, this means that the new NHS England must change itself. Put simply, it becomes “the way we do business” and will be part of our organisational development programme as we complete the merger of NHS England, NHS Digital and Health Education England.

Organisations and systems that deeply embed NHS IMPACT will have 5 key features:

  1. They have a shared purpose and vision – the board, executives and staff understand what they are trying to achieve, how they are going to achieve it and how quality improvement will support them to achieve their objectives. This applies to all providers.
  2. They invest in people and culture – they skill people up and change processes for improvement to become a routine part of what they are doing.
  3. Leadership behaviours where leaders are present on the frontline, listening to staff and patients about ways to improve services, helping and coaching them to move forwards and removing blockers on the way.
  4. Building improvement capability and capacity by providing training in improvement methodology for everyone at all levels throughout their organisation.
  5. And embedding this into management systems – and in every process including procurement, operational planning and HR.

It’s critical that we create the context and conditions in which organisations, including NHS England, and systems can work together to improve patient outcomes, to give staff better experiences when coming to work and to have real control over doing the things to improve what matters the most to them and to patients.

Culture is set by boards and executives, so leadership of the NHS is a key place for us to start to shape culture – and is why we are working on the development of the NHS IMPACT Leadership for Improvement Programme.

To support Providers to embed NHS IMPACT, we have developed an NHS IMPACT Self-Assessment. Access the NHS IMPACT Self-Assessment on our website –

This is the first NHS IMPACT Self-Assessment support tool to be made available. We are working with organisations, systems and primary care to co-produce tailored, Self-Assessments for these groups.

To find out more about NHS IMPACT visit or contact

Dr Vin Diwakar

Medical Director for Transformation and Secondary Care National Medical and Transformation Directorates NHS England.

Vin Diwakar is the Medical Director for Transformation in the National Transformation Directorate and leads on the secondary care portfolio in the National Improvement Directorate. He provides clinical leadership to improvement and transformation programmes including those which use improvement science, technology, digital, and data. He leads teams which are supporting improvement and transformation of a number of different clinical areas including diagnostics, urgent, emergency, acute and planned care and is responsible for improving clinical effectiveness.

In his previous role, he provided clinical leadership to London’s health and care system and was a key member of the multiprofessional regional team which led the capital through the COVID-19 pandemic.