OECD review on the Health Care Quality of the UK
Health systems in the United Kingdom have, for many years, made the quality of care a highly visible priority, internationally pioneering many tools and policies to assure and improve the quality of care. A key challenge, however, is to understand why, despite being a global leader in quality monitoring and improvement, the United Kingdom does not consistently demonstrate strong performance on international benchmarks of quality.
This report reviews the quality of health care in the England, Scotland, Wales and Northern Ireland, seeking to highlight best practices, and provides a series of targeted assessments and recommendations for further quality gains in health care. To secure continued quality gains, the four health systems will need to balance top-down approaches to quality management and bottom-up approaches to quality improvement; publish more quality and outcomes data disaggregated by country; and, establish a forum where the key officials and clinical leaders from the four health systems responsible for quality of care can meet on a regular basis to learn from each other’s innovations.
The UK is a global leader in monitoring and improvement, but doesn’t consistently perform well on international quality benchmarks, says the review.
The review, which focuses on each of the four UK countries, points to what it sees as influential factors, declaring that no one system has the edge over any of the others.
In England there’s an imbalance between central government and local accountability, it says.
Governance has shifted too far towards top-down regulation, which has the effect of stifling local innovation, and boosting disempowerment and distrust among those providing care. The proliferation of national agencies, reviews, and policies that address quality, have created “a somewhat congested and fragmented field of actors,” the report suggests.
Scotland has its own problems, says the review, suggesting that it needs to look for ways to support bottom-up approaches with stronger national frameworks. It suggests that Scotland establish its own national adverse events reporting system, for example.
And the country should also reconsider whether the meld of scrutiny and quality improvement activity within Healthcare Improvement Scotland represents a conflict of interest. The mix of these roles means that the system’s inspector risks “marking its own homework,” it says.
Meanwhile, in Wales, while local autonomy and innovation is encouraged, local Health Boards don’t seem to have sufficient institutional and technical capacity to drive meaningful innovation and quality gains, says the report. A stronger central guiding hand is now needed to play a more prescriptive role, it says.
In Northern Ireland, commissioning and performance management of health and social care have been integrated for over 40 years, and the Department of Health, Social Services and Public Safety has strategic oversight over both health and social care. But Northern Ireland could now do more to better exploit this collaborative structure to deliver more integrated and person-centred care, the report concludes.
You can reach the OECD report on the British healthcare system HEREPin It