by Laura Schang and Sarah Thomson

The systems designed to assure the quality of care in England are under intense scrutiny following serious failures of care at Mid Staffordshire NHS Foundation Trust between 2005 and 2008. With the Francis report proposing far-reaching changes to how quality in the NHS is assured and regulated, a new briefing outlines key insights from the final Lessons from Europe seminar. The Lessons from Europe seminar series is organised jointly by LSE Health, the NHS European Office and the Health Services Research Network with funding from the ESRC.

The final seminar of the series, in particular, examined what the NHS in England can learn from how European countries assure quality in a market-based environment.  

Drawing on approaches to quality assurance taken in Germany and the Netherlands, the analysis highlights a number of challenges for NHS leaders and policymakers in England to consider:

National analysis and local inspection: Using national analysis as a trigger for local inspections, as in Germany and the Netherlands, may support a more targeted approach to supervision. Such a risk-based approach to inspections should be calibrated by analyses of accepted indicators and definitions of what is being measured. For local inspections, it is vital to appropriately train healthcare staff to ensure consistency across providers. Patients could also be considered for the inspection team. Peer review arrangements may help to deal with the complexity of assessing modern healthcare.

Evaluating regulatory structures: Establishing an inspection regime, and indeed setting up an inspectorate itself, poses significant challenges. For example, an inspectorate would need up to date expertise and methodologies in keeping with advancements in medical treatments and/or the use of technology. This places great emphasis on the continuous evaluation of the regulatory structures in use, particularly on the impact of regulation on the quality of care, and the administrative burden of those regulated.

Linking inspection and improvement: Regulation of quality assurance requires levers to link quality measurement to quality improvement. Inspectorates will need clear responsibilities as to when to intervene, along with tools to ensure their findings are quickly taken up by providers and translated into policy changes. Improving complaints systems should go hand in hand with developing systems that prevent complaints from occurring in the first place.

For more information on the Lessons from Europe seminar series, please contact Sarah Thomson.

About the authors

Laura Schang is a doctoral student in the Department of Management at the London School of Economics and Political Science.

Sarah Thomson is an Associate Professor in the Department of Social Policy at the London School of Economics and Political Science and a Senior Research Associate at the European Observatory on Health Systems and Policies. She is currently a Senior Health Financing Specialist at the WHO Barcelona Office for Health Systems Strengthening.