This report is part of a series of publications reviewing the quality of health care across selected OECD countries. As health costs continue to climb, policy makers increasingly face the challenge of ensuring that substantial spending on health is delivering value for money. At the same time, concerns about patients occasionally receiving poor quality health care have led to demands for greater transparency and accountability. Despite this, there is still considerable uncertainty over which policies work best in delivering health care that is safe, effective and provides a good patient experience, and which quality-improvement strategies can help deliver the best care at the least cost. OECD Reviews of Health Care Quality seek to highlight and support the development of better policies to improve quality in health care, to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives.

The United Kingdom’s four health systems have much in common. They all offer population-wide insurance for the vast majority of health care needs, largely free at the point of use, through tax-funded single national pools. Similar values and service-models (such as a strong primary care sector) stem from a common heritage and evolution over the past 60 years. In addition, continuously improving the quality of care is a deeply established and widely shared commitment in all of the four systems. Each benefits from a bold and clear vision to achieve care that is consistently safe, effective and person-centred. The United Kingdom’s drive to continuously strengthen quality assurance, monitoring and improvement means that it has pioneered, or implemented more widely and deeply than elsewhere, several tools and approaches to monitoring and improving health care quality. The United Kingdom has become a point of reference, for example, in the development of evidence-based clinical guidelines; resources to support clinicians to stay up to date and engage in on-going professional development; use of patient surveys and patient reported outcome measures; data-linkage, transparency and public reporting; as well as reporting and learning from adverse events.

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. Although each system has pursued distinct policy priorities under the leadership of the devolved administrations over recent years, the four still have much in common in terms of context and challenges. Key amongst these challenges 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.

The English NHS takes health care quality seriously and makes great effort to be a system that learns. England has internationally pioneered many initiatives, including clinical guidelines, continuing professional development and use of patient surveys and patient-reported outcomes. Professionalism was for many years the base upon which quality monitoring and improvement activities rested. Over time, though, the governance model shifted toward a quality management approach, more reliant upon transparency and regulation. There has been a proliferation of national agencies, reviews and policies that address quality, leading to a somewhat congested and fragmented field of actors. This chapter recommends three key actions for England. First, greater emphasis on bottom-up approaches, led by patients and clinicians, should be encouraged. As the same time there is scope to simplify the range of institutions and policies regulating health care quality at national and local level. Finally, renewed focus on the quality at the interfaces of care, as well as on community-based services, is needed.

Scotland has set itself an ambitious quality agenda that strives to achieve health care that is consistently safe, effective and person-centred. This is underpinned by a bold public health vision that states that by 2020, everyone will live longer, healthier lives at home. Scotland has demonstrated keenness to play an internationally leading role in promoting health care quality, as evidenced by its innovative patient safety initiatives, world-class training programmes, and a clear desire to learn from patients’ experience. Scotland is also taking steps to integrate health, social care and other services for local populations, and has an abundance of data to measure the progress in achieving health system and outcome goals. Paradoxically, health and social care data is not reliably converted into information that can be used by local clinicians and managers, nor oriented towards the public, often enough. This chapter gives a series of recommendations to support Scotland strengthening the health care quality architecture, including around making better use of information systems, facilitating transparency and reporting to the public, supporting bottom-up approaches with stronger national frameworks, and creating a more independent mechanism for assessing health system performance systemwide.

Less than two decades after devolution, the Welsh health system remains a relatively young one; many of the institutions and mechanisms needed to promote high quality care are in place, but now a further push is needed to move towards a more mature, robust quality architecture. In many respects, “quality” is at the heart of the Welsh health system; this chapter describes Wales’ already-rich health care quality architecture. The ambition for an excellent, patient-centred health system, promoting quality, access and equity is clearly there in Wales, but now tangible practical steps are needed to make the necessary changes. This chapter makes a series of recommendations to support Wales in strengthening quality assurance and quality improvement. Assessment and recommendations are made across health system domains – from the role of accreditation and standards, to patient voice and professional training. Cutting across these domains, the priority should now be for Wales should be looking to increase accountability for delivering good quality and improving quality, and trying to establish some more concrete levers for positive system change.

Northern Ireland has established a robust strategic agenda for quality of care, but faces a difficult challenge in maintaining public confidence amidst sustained economic pressures and ongoing concerns over access. While the small scale of the system promotes a culture of trust, it is over-burdened by a governance structure that may benefit from further consolidation. Amidst an array of grassroots initiatives there exists a need to further promote effective learning and sharing across services and scaling-up of good practices. More metrics to drive benchmarking across services along with a strengthened role for the regulator are indicated. The integration of health and social care governance has been poorly exploited to date, with funding and service arrangements still in silos and a lack of incentives to encourage change. Further integration and development of general practice as a principal agent for co-ordinating community responses to health and wellbeing needs will help drive reform.