Quality improvement module 5: History of quality of healthcare in the UK

by Dr Charles Shaw and Adrian Worrall


Published: August 2020, with updates by Dr Amar Shah


The evolution of quality in UK health services has been one of consistent technical advances and complex cycles of values and behaviour. Frequent shifts in priorities and terminology, especially in the National Health Service (NHS), have led to relabelling, restructuring and loss of learning. The key dimensions of quality in healthcare remain unchanged, although we have seen an evolution of focus from planning to assurance to a deeper embedding of quality improvement within today's healthcare system.


Understanding how and why cycles recurred in the past helps to explain the present and, to some degree, the future. We can learn, for example, from recurring cycles in NHS policy, professional attitudes and public expectations. Observers around the world study closely how the UK, and specifically the NHS, have trodden this circuitous path. Similar reflection may also enable policymakers and practitioners in the UK to recognise where we are now and where we might go next in the quest for quality.


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This is the fifth in a series of modules developed in association with the College Centre for Quality Improvement (CCQI).



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