National Quality Improvement Working Group
Second Meeting
28th January 2008


Sir Liam Donaldson chaired the meeting and introduced guest speakers who gave presentations on examples of excellence.


Ann Keen MP the Minister with responsibility for quality and safety was present for the first part of the meeting, to listen to the early presentations, but was not present for the debate that followed.


An independent review had been conducted on quality in the NHS, and early findings were presented.  There will be a full report issued prior to the next meeting. 


The main themes that came out of the review highlighted the inconsistency across different Trusts in terms of quality care.  There could be better use of data to inform and drive improvements, there was a lot of information on statistics that was not used to drive improvements, one example related to the reporting of adverse events, there was little background information on how to learn from adverse events to avoid these happening again.  Some of these events would vary in severity and it is hoped that lessons were learned from the more severe events.


There were 1.8 million adverse events in 2004/05, around 35,000 every week, MRSA Action UK pointed out that if this was industry the NHS would be out of business.  From a patient perspective this was not acceptable, this would have an impact on the quality of care and patient safety.


A presentation was given on Stroke Services by two junior doctors who were working with Sir Liam Donaldson.  There were some excellent examples of quality care given throughout the patient journey, early referrals and diagnosis, the efficiency in which patients were treated had saved lives, rehabilitation, and innovative ways of joined up working were demonstrated.  The outcomes from the findings from the research into Stroke Services involved stakeholders, from patients and carers, through to clinicians and domestic staff involved in the patients' care.


Another presentation was given on the work with the Veterans' Association in the US.  VA had to change or it would go out of business, unlike the NHS, which is a publicly funded institution and does not have the same tension.  There was a debate around leadership and organisations wanting to change, it was felt that clinicians wanted to deliver the best service but were not always involved in the decisions on commissioning services, there was also a lack of political will within the UK to deliver consistent quality with changes in government and changes in initiatives and priorities.


One of the biggest challenges would be to get the political debate on delivering quality as a priority rather than worrying about seats on benches.


Using data to compare with other Trusts was useful, but there needed to be a change in dialogue, saying a Trust is excellent at delivering a quality service and has lower levels of infections is OK, but there needs to be a way of making that personal to clinicians.  Saying Jo Bloggs has found an innovative way of tackling this problem will make clinicians want to go away and talk to him to find out how he is doing this.  League tables don't give that message, they can be negative as well as positive - it's how you use them.


There had been no measures for safety within the NHS until the MRSA target evolved.  It was felt that by doing something about reducing avoidable infections we will improve our culture and safety, people are beginning to understand that to focus on minimising infections, it is about safety as well, and it will unleash the power of what clinicians can do at a local level, just let go.


Derek outlined that implementing human performance is about giving power back to the coalface, let them run the ward but let them run it efficiently.  The training and the leadership has to be there to get those people to take on board change. 


It was important to remember that the customer is not always right, but the customer must always come first - that's the patient, the patient may not always be right, but they do come first.  Listen to patients, that's the feedback on quality, listen to good and bad, when you get a complaint use it as a free learning lesson, it's a consultancy from that person, find out what where you went wrong, and change it to ensure another patient isn't affected adversely.


MRSA Action UK presented a discussion paper to Sir Liam Donaldson on Human Performance, Tools and Techniques.  The paper discusses how to apply a systematic approach to delivering safe, quality healthcare.


The next meeting of the Quality Improvement Working Group will be held on 26th February 2008.


Derek Butler


MRSA Action UK


Click here for Terms of Reference and Membership of the Group


For more information contact Derek Butler