Making an IMPACT

I felt very privileged to chair the first meeting of the new NHS National Improvement Board in September. It’s wonderful to be involved in embedding improvement across the NHS. This isn’t a full-time role for me though. My “day job” is to be the Chair of Lancashire and South Cumbria NHS FT (LSCft). We deliver mental health, learning disability, autism and some community physical health services to 1.8 million people living in the north-west of England.

Recently, myself and fellow LSCft Board members had a wonderful time meeting teams who had been working on improvement projects. We heard about how they had reduced the use of restrictive practices on our inpatient mental health wards, cut the incidence of falls, involved people with lived experience in their work, and tackled waiting times in our eating disorders and dental services. The staff we met were full of enthusiasm and glowing with pride at the difference they had made for patients. I know that there are countless similar examples in Trusts in every part of the country.

The aim of NHS IMPACT (Improving Patient Care Together) is to instil this spirit into everything that we do in the NHS. Not just through one off ‘projects’ but by encouraging and supporting everyone to improve the work that they do every single day. If we’re going to achieve this, we can’t just rely on those who are already improvement enthusiasts. We need staff at every level to see the benefits in their daily work. We need the Boards of organisations to put time and effort into leading this change. We need not just the Medical, Nursing and HR Directors to be involved, but Chairs and Non-Executives, Chief Executives, Finance Directors and Chief Operating Officers too.


NHS IMPACT is a shared approach to improvement for the NHS. A shared improvement approach doesn’t mean that every Trust or system has to adopt the same improvement method.. We are keen to foster local innovation, so the way in which improvement work is described in each place will vary according to local circumstances. There is clear evidence that the best healthcare organisations in the world, including here in the NHS, place improvement at the heart of all that they do. There are five components which together make up the DNA of an improvement culture, and it’s these five which NHS IMPACT is seeking to promote across the NHS as a whole.

These are:

  1. Building a shared purpose and vision.
  2. Investing in people and culture.
  3. Developing leadership behaviours
  4. Building improvement capability and capacity.
  5. Embedding improvement into management systems and processes.

How are we moving NHS IMPACT forwards?

The National Improvement Board has agreed five short-term priorities as we establish NHS IMPACT over the coming months. These are:

1) Promote NHS IMPACT vision, aims and framework

We will be using a wide range of forums and networks to raise awareness and gather ideas. This will be brought to life by real-world case examples of improvement in action.

2) Inspire and encourage Trusts, places, systems to progress on their improvement journeys

We have codesigned a self-assessment tool in relation to the five components of NHS IMPACT. We strongly urge all Boards and Chief Executives to engage directly with this, to reflect honestly on where you are currently, and to develop a plan to move you forward. There is no intention to ask Trusts and Systems to share self-assessments with NHS England. The aim is to support genuine reflection and learning.

3) Strengthen delivery of key priorities, including safety, using an improvement led approach

There is a huge amount of time and effort currently being expended to tackle the challenges that we face in urgent and emergency care, elective recovery, primary care access, the delivery of mental health services and patient safety. All of these will benefit from a stronger improvement focus both at a local and at a national level.

4) Mobilise a network of support partners

We are fortunate to have many people with expertise and enthusiasm for improvement right across the NHS. We also have a range of NHS support organisations who can provide facilitation and development. Our aim is to connect these individuals and groups together to focus their support on the places and priorities that need it most.

5) Engage, support and encourage NHSE’s own improvement journey

NHS England is going through far-reaching change following its merger with NHS Digital and Health Education England. This provides a great opportunity to bring together the redesign of the processes of care with the transformation of our workforce and the opportunities presented by digital innovation. NHS England recognises that it will be able to do this more effectively if it too adopts the five components of NHS IMPACT.

What can you do?

We want you to be a part of this as it moves forwards, whatever role you are in.

Firstly, I would urge you to find out more. Be curious. Take a look at our website. Discuss NHS IMPACT with your colleagues. Access some of the discussion groups that are being set up by organisations like the NHS Confederation, NHS Providers and the Health Foundation.

Secondly, we are keen to learn from you. Please send us your questions and comments to Share your local experiences of improvement, both the data and how you have gone about your work. Share your stories of achievement but also your stories of what didn’t work and your learning from that.

Finally, get involved. We expect that Trusts and systems will be initiating work on their own self assessments and framing their improvement development plans. We also expect that this will accelerate the range and scale of improvement activity, learning and development right across the NHS. What part can you play in that?

I know from personal experience that it isn’t easy to free up the time engage with this alongside a busy day job. But I guarantee you it will be the most enjoyable and satisfying part of your working week if you are able to do so.

David Fillingham

David joined the NHS in 1989 after working in manufacturing. He held several chief executive positions and served as the Director of the NHS Modernisation Agency from 2001 to 2004, where he focused on developing new practices and fostering leadership development across the NHS. He received a CBE for his contributions.
In 2010, David became the National NHS Quality Champion and later retired from the NHS in June 2019 after serving as the Chief Executive of AQuA. Additionally, he held various non-executive roles and served as a visiting Senior Fellow at The King’s Fund. David has particular interests in quality improvement, leadership development, co-production with the users of services and partnership working.