A decade of delivery of high-quality care starts now
At its best, the NHS saves lives, reduces suffering and gives people the confidence that they will be well looked after when they are most vulnerable. But this is not everyone’s experience. Too often, and for too many people, the NHS is falling short of that promise.
Based on the commitments in the 10 Year Health Plan for England, the Quality strategy for NHS-funded care in England sets out our ambition for a decade of sustained, measurable improvement in the quality of NHS-funded care. It supports the 3 shifts in how care is delivered – hospital to community, analogue to digital, treatment to prevention – underpinned by 10 enablers for delivery.
It is a strategy for the whole system. It applies to all NHS-funded services, regardless of provider or setting, and to the NHS leaders, healthcare staff and the wider partners whose actions shape the health of local communities.
Its aim is simple: to ensure that high-quality care is available to everyone, wherever they live.
This means improving each of the 3 domains of quality: safety, effectiveness and experience. Together, these capture what it means to receive genuinely good care.
Progress across all 3 domains is essential; a strategy that focuses on one at the expense of the others will fall short. This strategy is built on the conviction that progress across all domains, pursued together and in balance, is both possible and necessary.
Within this, safety is the foundation of high-quality care. It depends on skilled staff, appropriate infrastructure, effective systems and safeguards, and on the consistent application of basic standards. These are not yet in place everywhere, so improving how safety is managed and assured remains a core priority for providers.
At the same time, effectiveness must improve. Variation in care, late diagnosis and gaps in primary and community support lead to poorer outcomes and avoidable hospital use. Tackling this is central to improving population health and making better use of resources.
Alongside safety and effectiveness, experience must be recognised as integral to quality. For too long, people’s experience of care has been overlooked, contributing to falling satisfaction and poorer outcomes. High-quality care must be safe, effective and centred on what matters to people.
What the evidence tells us: the starting point
We need to be honest about the scale of the challenge.
The 2024 Darzi Investigation describes an NHS under serious pressure. Healthy life expectancy in England has declined in recent years, and inequalities are widening, with the gap between the most and least deprived communities standing at 15.8 years for females and 14.7 years for males.
Over 20% of deaths in England are classified as avoidable, whether due to preventable risk factors, poor management of long-term conditions or late presentation and detection of treatable conditions. Public satisfaction with the NHS remains below pre-pandemic levels, despite some recent improvement.
Too many people are experiencing fragmented, inconsistent care that fails to meet the standards they should expect.
Why this strategy, and why now
This strategy does not exist in isolation. It supports the 10 Year Health Plan for England, which sets out the government’s long-term vision for transforming the NHS through radical transparency, a renewed emphasis on patient and staff voice, and a determination to tackle healthcare inequalities. This strategy translates those commitments into a coherent framework for action.
It also responds to the Dash Review’s call for the National Quality Board (NQB) to take a more strategic and co-ordinated approach to quality management across the system. This approach is grounded in a commitment to value: deploying resources where they will yield the greatest benefit for health and society.
The timing is deliberate. New care models, a restructured operating model for the NHS, investment in neighbourhood health and a renewed focus on prevention create the conditions for a step change in quality.
But structural reform alone will not improve outcomes. That requires a clear, system-wide commitment to quality as the organising principle of NHS-funded care – not a parallel workstream or afterthought, but the purpose that shapes how services are designed and delivered.
That is what this strategy provides.
What we are trying to achieve
This strategy aims to improve healthy life expectancy, reduce healthcare inequalities and increase healthcare value.
Within a decade, people using services across England should be able to expect care that is consistently safe, reliably effective and responsive to people’s needs.
Premature and avoidable deaths will fall. People will receive earlier and faster diagnoses and more effective treatment for cancer and other serious conditions. Prevention of cardiovascular disease and outcomes for those affected – the single biggest cause of premature death – will improve markedly. Maternity and neonatal services, which have been subject to too many avoidable tragedies, will be safer and provide a positive experience for women and their families. Mental health services will meet the same quality standards as physical health services.
Inequalities will reduce. The CORE20PLUS5 approach will be implemented systematically, with targeted action where gaps in access, experience and outcomes are widest.
Integrated care boards (ICBs) will undertake value-based commissioning with a full understanding of the needs of their population.
The NHS will deploy technology to benefit people using services, families, unpaid carers, staff and the public, and become the most transparent healthcare system in the world.
Data about quality will be open, accessible and meaningful. People will be able to understand how providers are performing and how they are improving. Staff and leaders will use data as a tool for improvement, not just accountability.
How we will make this happen: the 10 enablers
Achieving this ambition requires the right conditions, structures and support across the whole system. This strategy sets out 10 enablers that together will create those conditions:
- clarifying who is responsible and accountable for quality at every level of the healthcare system
- setting clear priorities to improve the quality of care while adopting a transparent, coordinated and value-based approach
- strengthening leadership and management capability to create the right culture and conditions for improvement
- listening to and working with people and communities on what matters to them
- using data to manage quality, inform decisions and support accountability at all levels
- increasing transparency, making the NHS the world’s leading healthcare system for public access to information on care quality
- developing and embedding technology to underpin quality management and improvement
- aligning incentives and rewards with accessible, high-quality and productive care
- promoting innovation and research to support continuous improvement in both clinical care and how the NHS operates
- creating a more co-ordinated and improvement-focused approach to regulation
How we will know the strategy has been delivered
Accountability for delivery is built into this strategy.
The National Quality Board will oversee progress against the strategy’s ambitions at a national level. It will use a core set of quality metrics – across safety, effectiveness and experience – triangulated against other quality intelligence to give a consistent and publicly accessible view of how care quality is changing across the system.
Responsibility for quality is shared across the system, but accountability for quality management and outcomes must be clear and sit at organisational level.
The accompanying technical annex provides a baseline for measuring progress, including trends, variation across the country and inequality gradients.
Specific goals and standards for each pathway and service area will be set out in the relevant modern service frameworks and plans, such as the National Cancer Plan.
The National Quality Board will report publicly on progress, providing a clear account of what is improving, where progress is too slow and what action is being taken.
A call to action
This strategy asks something of everyone who leads, delivers or shapes NHS-funded care.
It asks NHS boards and senior leaders to make quality their core purpose, building the cultures, systems and capabilities that make high-quality care possible and being accountable for progress.
It asks clinical leaders to champion improvement in their own services and specialties, researching and sharing what works and challenging what falls short.
It asks commissioners to apply genuinely value-based principles to their decisions, directing resources to where they will deliver the greatest benefit for people and communities.
It asks every member of staff – clinical and non-clinical – to see quality improvement as their responsibility, not someone else’s.
And it asks the system as a whole to be honest: about where care is falling short, why and what it will take to put things right.
The prize is significant. Fewer avoidable deaths. Longer, healthier lives. Care that people can trust. An NHS that fulfils its founding promise, to every person, in every part of the country.
The evidence shows that the NHS can deliver when it commits to clear priorities, effective implementation and real accountability. The task now is to do this at greater scale, across all domains of quality.
The work starts now.