Final Report > Chapter 6: Quality, Standards and Information > National policy towards quality

National policy towards quality

4 National policy towards the quality of healthcare up to the late 1980s (and beyond) focused on the effective and efficient use of resources (value for money), and on a concern for the number of patients treated, sometimes referred to as `levels of activity', or `throughput'. Concerns over lengthening waiting lists for treatment, and how to tackle them, became important elements in national policy. The view was generally held that the longer the waiting list, the greater the possibility that the condition of a patient on that list would deteriorate. To that extent, tackling waiting lists was an initiative linked to improving the quality of care provided. Patients were becoming less tolerant of having to wait for treatment. Thus, the need to reduce the size of waiting lists overall and, simultaneously, to reduce the length of time patients spent waiting became important elements of public policy. The quality of the care which patients would receive, however, when they were finally admitted to hospital, and the outcome of that care, were not high on the political agenda. It was assumed that care would be good.

5 The arrangements for managing the NHS between 1984 and 1995 reflected these prevailing attitudes. The quality of clinical care was an area into which managers ventured with trepidation. Sir Graham Hart, Permanent Secretary at the Department of Health (DoH) from 1992 to 1997, told us of `a deeply-rooted reserve' [2] in government about matters to do with clinical performance. It was something traditionally thought of as being the exclusive domain of the professions.

Footnotes

[2] T52 p.36 Sir Graham Hart