Introduction

The quality and safety of healthcare remains a global health policy priority with the likes of the World Health Organization and major international forums promoting standards and methods for improving care quality (WHO 2022). The English National Health Service (NHS) exemplifies such trends where the significance of quality as an NHS priority has been framed, in a large part, by the many high-profile failings and scandals in care quality dating back to the late 1960s. Scandals around long-term care at Ely, unsafe paediatric heart surgery at Bristol Royal Infirmary, the systematic neglect of patients at Mid-Staffordshire hospital and very recently, the prominent failings at multiple maternity units provide a disturbing backdrop to the NHS and the quality of care (Mannion et al, 2018; Knight and Stafford, 2022). Such events have often been followed by investigations and Public Inquiries and led to extensive recommendations, many of which look similar from one report to the next, arguing for increased transparency, support for speaking up and whistleblowing, culture change, better governance and reforms of professional regulation (Powell, 2019).

The response to quality failings has instigated a range of regulatory responses and the need for greater quality assurance (Waring et al, 2010). National improvement and performance management programmes from the early 2000s onwards have been implemented by a succession of regulatory bodies from the Centre for Healthcare Improvement (CHI) followed by the Healthcare Commission and then the CQC. In responding to such events, the NHS has also been the testbed for many innovations in quality improvement and management, often drawing from the experiences of other safety-critical or high-quality industries (Waring and Bishop, 2010; Millar, 2013). This is exemplified by the growth of specialist agencies and charities committed to promoting care quality such as the Modernisation Agency, the Institute for Innovation and Improvement, NHS Improvement and The Health Foundation (The Health Foundation, 2021).

And yet despite such an emphasis and policy innovation, the commitment to quality and quality improvement has not been constant. The focus on quality and quality improvement has competed for attention among other policy priorities, especially cost and responding to exogenous events such as the COVID-19 pandemic. Such variable traction and success have led to the quality agenda appearing more like fads and fashions rather than a sustained policy approach (Ham, Berwick and Dixon, 2016; Molloy, Martin and Gardner, 2016).