First Quality Strategy for NHS-funded care in England

The new national Quality Strategy was published on 14 July 2026 and has been designed to sit alongside the 10-year health plan to provide clarity on quality measurement, transparency and improvement within a quality landscape that had become “crowded and unclear”.

NHS England’s Quality Strategy positions quality as the “organising principle” for all NHS funded activity in England over the next decade. Developed by the National Quality Board (“NQB”), the strategy brings together existing commitments from the 10-year health plan and the Dash review into a single national framework.

The strategy places a renewed emphasis on accountability, outcomes, transparency and reducing variation. It does not set new targets or requirements. However, it does signal a bigger role for data, technology and AI in supporting quality improvement and oversight.

The strategy places primary responsibility for quality with local organisations, including NHS providers and integrated care boards. They observe that attention has tended to focus more on hospitals, secondary care services and individual organisations than on primary, community, mental health settings or whole care pathways (despite general practice delivering over 400 million appointments each year).
Boards and senior leaders are expected to create the conditions in which quality is planned, monitored, improved and assured. For ICBs, that responsibility comes at a particularly challenging time, as commissioners manage significant cost pressures, organisational restructuring and low staff morale.

A need to anchor quality within the three shifts of care set out in the 10 -year health plan has been identified.

While social care is outside the strategy’s scope, it recognises the need for “strong partnerships between health and social care to improve quality where services meet”.

The Independent Healthcare Provider Network’s director of regulation welcomed the strategy’s focus on quality and safety but questioned its focus on NHS-funded care, arguing that a broader system-wide approach would better reflect the increasingly integrated NHS and private care pathways.

With 15 chapters and three annexes there is a lot to digest but we have pulled out some key points to take on board.

What is high-quality care

The strategy’s definition is based on three core principles of quality:

• Safety: Reducing the risk of unintended or unexpected harm to patients arising from the provision of healthcare.
• Effectiveness: Delivering evidence-based care that optimises the outcomes that matter to people using services.
• Experience: Co-ordinated, compassionate and responsive care, delivered by staff who are skilled, supported and able to do their job well.

Role of NQB

Their strengthened role is designed to:

• Improve oversight
• Support transparency and public confidence
• Ensure robust public protection
• Reinforce accountability to Parliament

How quality improvement will be supported

The strategy sets out the following 10 enablers for quality improvement:

1. Clarifying who is responsible and accountable for quality at every level of the healthcare system
2. Setting clear priorities to improve the quality of care while adopting a transparent, co-ordinated and value-based approach
3. Strengthening leadership and management capability to create the right culture and conditions for improvement
4. Listening to and working with people and communities on what matters to them
5. Using data to manage quality, inform decisions and support accountability at all levels
6. Increasing transparency, making the NHS the world’s leading healthcare system for public access to information on care quality
7. Developing and embedding technology to underpin quality management and improvement
8. Aligning incentives and rewards with accessible, high-quality and productive care
9. Promoting innovation and research to support continuous improvement in both clinical care and how the NHS operates
10. Creating a more co-ordinated and improvement-focused approach to regulation

Additionally, the strategy identifies Quality Management Systems (QMS) as the mechanism through which local organisations can manage quality in practice. NHSE will shortly publish a QMS framework which will set out how NHS organisations can embed a QMS approach. It also notes that as QMS approaches are embedded, they should remain aligned with the CQC Well-led framework.

In parallel, NHSE are publishing a number of Modern Service Frameworks that set out to standardise care and quality in specific health conditions.

Maternity and neonatal services

There is a separate section on making sustained improvements.

Changes coming

The NHS patient safety strategy launched in 2019 will be reviewed and refreshed following the publication of this strategy, particularly in supporting systems to respond to safety issues more effectively in real-time and balance the risks as patients move through the system. 
In addition, a Directorate of Patient Experience will be established in DHSC and there will be reform of complaints regulation to make processes more effective and transparent.

Accountability

The strategy clearly states that quality management is a shared responsibility across the system but accountability for quality management and outcomes must be clear and sit at organisational level.

It goes on to say that Boards, executives, practice partners and clinical leaders are ultimately accountable for the quality of care their organisation plans, commissions or delivers, including day to day oversight, proactive improvement and responding when things go wrong.

Therefore, leaders must actively measure, manage and improve quality. This accountability must be exercised locally through robust governance, transparent reporting and effective oversight, with national leadership ensuring that quality management is recognised as a core responsibility that results in action and improvement.

Strategic commissioning

The strategy states that to support the commissioning of high-quality services, ICBs should:

• Appoint a designated executive lead, accountable for ensuring commissioning improves quality and delivers better healthcare value
• Establish clear, streamlined governance and escalation processes for quality oversight, with the board or a designated committee (either a standalone quality committee or an integrated committee) gaining assurance that services are commissioned in a way that supports continuous improvement
• Share intelligence across the system, including through system quality groups, to identify risks and improve services

Delivery of care

Given the early reference to primary care, the strategy goes on to highlight that in primary care, individual providers are responsible for quality but, as there may be limited organisational infrastructure, collaborative working through PCNs, federations or other local networks – supported by ICBs – is essential to:

• Share learning
• Maintain effective communication across organisational boundaries
• Support early identification of risks or variation across practices and pathways while preserving practice-level flexibility and efficiencies

Managing quality across organisational boundaries

Clearly managing and improving quality depends on how effectively organisations work together at key interfaces of care, including:

• The point of discharge
• Transition between children’s and adult services
• At the boundaries between the health and the care system

The strategy emphasises how this requires proactive, early sharing of intelligence, effective communication and improved co-ordination of care between settings, providers and sectors. Again, they note how primary care plays a central role in this, providing continuity of care, co-ordinating across services and supporting early identification and management of risk.

Recommendations

As if anticipating a recommendation from an Inquiry sometime soon, we are told that the NQB will create and maintain a repository of national recommendations arising from reports, reviews, inquiries and investigations. In doing so, it will operate as a recommendations hub, supporting:

• Coordination and prioritisation of recommendations
• Assessment of likely impact, cost effectiveness and alignment with strategic priorities
• Clearer national and local action on what matters most

Transparency

A hugely important section of the document comes at chapter 9.

Here it explains how transparency is not only about accountability; it is central to improving quality. It enables earlier risk detection, reduces unwarranted variation and supports research. It also helps create a culture that is open, honest and focused on learning, including being open with people when things go wrong and learning from incidents, in line with the statutory Duty of Candour.

The government are also intending to reframe Quality Accounts to provide clearer, more meaningful information on safety, effectiveness and experience, including how organisations respond when things go wrong.

Putting this strategy into practice

The strategy is published along with annexes covering:

• Annex A: Core quality responsibilities of regions, ICBs and services providers
• Annex B: Local actions to strengthen leadership and management capabilities for quality

Embedding quality as part of the everyday will be key to realising the ambitions of the 10-year health plan.

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