The satisfy specific customer or user requirements”.

The National
Health Service (NHS) is a health service that is available to everyone living
in the UK. It is free at the point of use, so if a person falls ill then they
do not have to pay for their treatment outright, however it is generally paid
for through taxation. The NHS must always provide high quality care, because in
England, the service can potentially deal with over 1 million patients every 36
hours. Therefore, if the quality drops below a certain standard, lives could be
lost. This essay will discuss how quality is achieved and monitored within the
NHS. Firstly, the definitions of ‘quality’ will be considered before looking at
how it is achieved. Then, the essay will outline and examine the monitoring of
quality in the NHS.


In terms of
manufacturing, ‘quality’ is “a measure of excellence or a state of being free
from defects, deficiencies and significant variations brought about by strict
and consistent commitment to certain standards, that achieve uniformity of a
product to satisfy specific customer or user requirements”. However, this
version of the definition, provided by the International Organisation for
Standardization (ISO), cannot necessarily be applied to healthcare and the services
provided by the NHS due to customer expectations. Recommendations, personal
needs and past experiences tend to determine these expectations. Thus, a
different definition that considers any potential issues with quality. Service quality
(SQ) is a comparison of (user) expectations (E) with performance (P), therefore
‘SQ = P – E’. Kevin, Kristine and Berry (1985) highlighted the main
requirements for delivering a high-quality service and identified five gaps
that cause unsuccessful delivery and the potential causes of these gaps – these
can relate to healthcare. For example, ‘Gap 1’ is between consumer expectation
and management perception – this is where the organisation/management does not
correctly perceive what the consumers want. In terms of healthcare,
administrators of a hospital may believe that patients want better food, but
the patients may actually be thinking about the responsiveness of the nurses
instead. This may be due to limited marketing research, insufficient interpretation
of information about customer expectations, or inadequate communication about
the patients, as a consequence of the presence of too many layers between
front-line staff and top-level management. However, there are issues with
applying the SQ ‘equation’ to healthcare – patients may not know or understand
whether their experience or procedure was of high quality, therefore they may
feel that their expectations had been met, but the standards that the ISO have
may not have been met by the staff, thus leaving a gap that the patients or
‘customers’ did not know existed. Having discussed what is meant by the term
“quality” in the context of healthcare, I can now examine how it is achieved in
the National Health Service in England.

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To guarantee
that basic quality standards are achieved by all clinicians and healthcare
practitioners in all sectors of the NHS, an organisation called Health
Education England (HEE) ensures that the NHS employs a skilled workforce. As a
result, doctors, nurses and other staff will have the correct skills to care
for every patient, despite the severity of their illness, to the highest
standard. Additionally, there are Local Education and Training Boards (LETBs)
which are committees of HEE. They are responsible for providing education and
training to healthcare professionals such as doctors, nurses and dentists at a
local level. This certifies every clinician, meaning that they are capable of
caring for each individual patient, thus achieving quality within the NHS in
all sectors.


In 2001, the
NHS introduced ‘Star Ratings’ where hospitals, ambulances and primary care
services in England were given ‘hotel-style’ ratings from 0 to 3, 0 being the
worst and 3 being the best. Things such as waiting times and cleanliness are
examined, and different things are analysed differently when being examined,
for example, ambulances lost marks if they did not respond to 999 calls quickly
enough. These ratings are published by the Healthcare Commission from 2004, who
said that health service in England was improving overall, despite some of the
‘best’ hospitals failing to gain the top stars. Nevertheless, critics said that
the stars were “meaningless and inadequate” – they did not provide sufficient
qualitative data for the public to understand why the services were deemed
‘bad’ and which part of the service performed the poorest. Despite this, the
ratings help the NHS to achieve quality as it demonstrates which parts are
struggling and how they can potentially progress.


The NHS Next
Stage Review final report by Lord Darzi (2008) proposed high quality care for
all. The English NHS required a more sophisticated strategy as a way of meeting
targets and increasing performance, as well as strengthening the capability and
capacity of NHS leaders, so that high quality and effective patient care is
constantly delivered. There were three essential elements that must be
considered in the Next Stage Review – treatment and patient care must be
effective and safe, and their overall experience must be positive. The final
report included some advisories, for example, there should be more emphasis on
‘personalisation’ of the NHS, which is led by local change rather than national
targets. It also led to the creation and publication of the NHS Constitution in
2009, which sets out rights and responsibilities for patients, public and
staff. The review by Darzi helps to achieve quality in the NHS as it has
changed the way that care is delivered, it has become more personal instead of
the patient just being a ‘statistic’.