NHS IMPACT – where are our members starting from?

Julian Hartley profile picture

26 October 2023

Julian Hartley
Chief Executive

In September, the inaugural meeting of the National Improvement Board (NIB) took place. The NIB is composed of integrated care board (ICB) and trust chief executives, clinicians, improvement experts, and national leaders, with David Fillingham serving as the chair and Professor Andy Hardy as the deputy. Their primary objective is to strategically guide the successful implementation of NHS IMPACT (Improving Patient Care Together), a programme launched earlier this year by NHS England to foster the development of behaviours, skills, and techniques necessary for continuous improvement in NHS organisations at all levels. 

This meeting provided me, a member of the NIB, the opportunity to reflect on the hopes and aspirations that underlie NHS IMPACT. These hopes are shared by our members who have welcomed this new universal approach. As we collectively consider the next steps for continuous improvement, NHS Providers has conducted a survey of where trusts feel they are in their improvement journey – at organisation level and within provider collaboratives.

This survey complements the recent baseline survey initiated by NHS England regarding improvement capacity and capability at provider, system, regional and national levels, along with ongoing self-assessment work within trusts. The combined insights from these efforts can contribute to more informed decision-making and help us fulfil our shared vision for every place and system to have its own management system and a culture focused on continuous improvement supported by a robust methodology within the next five years.

NHS England's baseline survey received a strong engagement and response rate, indicating the level of enthusiasm. Our survey asked different questions, providing further insights on how respondents within providers view their improvement journey and exploring progress on trust-wide, systematic improvement specifically. It also sought board members' perspectives on how their approach compares with the expectations set by NHS IMPACT. Additionally, we aimed to capture the emerging landscape of shared approaches to improvement within provider collaboratives. Key findings: 

Where trusts are now

  • 22% of respondents said they have largely implemented, embedded and sustained a systematic, trust-wide improvement approach over several years.
  • 50% said they are currently implementing such an approach and making progress, with a need for further maturation.
  • 14% reported that their trust had just begun implementing a systematic approach.
  • 5% reported that frontline teams in parts of the organisation are using structured improvement methods and approaches, but they have yet to make a commitment to take a systematic, trust-wide approach.
  • Just 7% of respondents reported that they have made a commitment to a systematic, trust-wide improvement approach and are thinking about where to begin.
  • Hearteningly, 75% of respondents stated that their trust's approach to quality improvement is fully or mostly aligned with the components outlined in NHS IMPACT.


Barriers to improvement at trust level 

  • Operational pressures were a significant challenge, cited by 75% of respondents.
  • Engaging overburdened staff was a challenge for 68%.
  • 64% mentioned a lack of workforce capacity.
  • Regarding support, trust leaders expressed a desire for assistance in developing leadership behaviours for improvement (64%), investing in culture and people (58%), and building shared purpose and vision (53%).


At the provider collaborative level, shared approaches to improvement are still in their early stages 

  • 5% of respondents reported that their provider collaborative has largely embedded a shared approach and is seeing impact.
  • 17% mentioned that their shared approach to improvement is underway.
  • 38% stated that they have just started on this journey.
  • Additionally, 25% of respondents indicated that their approach to quality improvement across their provider collaboratives is fully or mostly aligned with the components outlined in NHS IMPACT.

Common barriers across provider collaboratives

  • Lack of robust shared systems, including IT and shared data systems (50%).
  • Insufficient workforce capacity (44%).
  • Operational pressures taking precedence (43%).
  • Members expressed a need for support in developing leadership behaviours for improvement (66%), embedding a quality management system (60%), and building shared purpose and vision (58%).

Health inequalities also emerged as a top priority for respondents in terms of enablers of improvement at trust level (64%) and provider collaborative level (63%). Our new Provider Collaboratives: Improving Equitably programme is adapting to address this need, emphasising leaders' roles in promoting shared improvement with an equity lens from the start. 
There is a strong appetite for NHS IMPACT as it builds on existing capabilities within the provider sector and reinforces efforts at the trust and provider collaborative levels. It provides a shared framework and values for us to work together toward a better future for our staff and patients. It also offers the opportunity to deepen all boards understanding of what it takes to embed a systematic approach and where they are on their journey, as well as align people around terminology and what good looks like.

While improvement approaches are a critical part of the solution to the unprecedented operational challenges we face, there is limited resource to deliver it at pace and scale.

Julian Hartley    Chief Executive

While initial success is likely to lie at trust level and through collaboration between providers, there is still a gap between where we are now and where we want to be. It is crucial we anchor the operationalisation of NHS IMPACT in today's reality while also taking a long-term view. Improving organisations and systems takes time. While improvement approaches are a critical part of the solution to the unprecedented operational challenges we face, there is limited resource to deliver it at pace and scale. It is not straightforward for leaders or staff to manage capacity of the day job with time to think outside the box when the pressures are so great. 

Trust leaders are eager for guidance on how to implement NHS IMPACT locally and clarity on how it aligns with other key policy areas, such as the Patient Safety Strategy and the new Patient Safety Incident Response Framework. These implementations cannot be separated from discussions on funding, staff, training, infrastructure, and other prerequisites for safe, high-quality care.

The work to support NHS IMPACT can leverage lessons from previous NHS investments, such as the VMI-NHS evaluation, focusing on building cultures for improvement and cultural readiness. The commitment of NHS England to its own improvement journey is a crucial signal for the entire system, emphasising the integration of NHS IMPACT at all levels. 

I have personally witnessed the transformative power of a systematic approach to improvement during my tenure as the chief executive of Leeds Teaching Hospitals NHS Trust.

Julian Hartley    Chief Executive

NHS Providers is well-placed to support these efforts, building on existing programmes and partnerships with the Q Community and Health Foundation to facilitate learning and share resources for systematic approaches to improvement among board leaders. 

I have personally witnessed the transformative power of a systematic approach to improvement during my tenure as the chief executive of Leeds Teaching Hospitals NHS Trust. By implementing improvement methods and empowering staff and patients, we enhanced care quality, patient safety, and the overall patient experience. We also improved financial and operational performance and staff satisfaction. This approach was integral to our way of working and my own leadership.

NHS IMPACT, with sustained focus and investment from all stakeholders, provides an opportunity to achieve similar benefits on a larger scale. There is a strong desire to make it work, aligning existing capabilities and working collaboratively to create a culture of improvement centred on delivering high-quality patient care. This goal has never been more important.

Click here for the full survey results. Data drawn from 129 respondents, from 95 trusts (45% of trusts in England).

About the author

Julian Hartley profile picture

Julian Hartley
Chief Executive

Sir Julian Hartley joined NHS Providers as chief executive in February 2023, having been chief executive of Leeds Teaching Hospitals since 2013. NHS Providers is the membership organisation for the NHS hospital, mental health, community and ambulance services that treat patients and service users in the NHS. We help those NHS foundation trusts and trusts to deliver high-quality, patient-focused care by enabling them to learn from each other, acting as their public voice and helping shape the system in which they operate. NHS Providers has all trusts in England in voluntary membership, collectively accounting for £104bn of annual expenditure and employ 1.4 million staff. Read more

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