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Health and Care Quality Systems in practice: A guide for local leaders

Quality is ‘everyone’s business’ and different players have different roles in the system. This guidance suggests that the key to success is to ensure effective coordination at local level, whilst making sure everyone is doing their own job well.

There are many ways of achieving this, and of ensuring wide involvement of local people in this work; this guidance, and the materials linked to it, are intended to give prompts and examples for local leaders who have responsibilities in this area.

The checklist below summarises the responsibilities of different local groups and agencies – and might help in the design of your local quality system.


All those with leadership responsibility at local level should:

• champion the importance of good quality services
• champion the importance of providing channels for people to feed back about their experience, and listening to their views and embed co-production as a principle when designing services
• promote a culture of openness and continuous learning, amongst all the relevant organisations
• challenge provider organisations about their internal quality assurance processes and ensure they are accountable to the public
• challenge commissioning organisations about how they are monitoring quality, and ensure they are accountable to the public.

Health and wellbeing boards (HWBs) should:

• make themselves aware of how quality is being monitored locally, and of the priority issues and concerns in their locality
• where necessary, ensure action is taken and reported on those priority issues,
• ensure a joined up approach, and good information-sharing, between agencies
• be aware of the work of the quality surveillance group for their area – which coordinates quality assurance activity for the NHS
• identify the priorities for fuller scrutiny (eg by Healthwatch and/or the overview and scrutiny committee).

Local Healthwatch should:

• keep in touch with local people’s experience of services
• channel information from networks of voluntary and community groups, identifying any key themes or trends
• alert commissioners and planning and scrutiny bodies (including the health and wellbeing board and overview and scrutiny committee) to any significant concerns
• carry out bespoke research into people’s experience in priority areas, having consulted about what these priorities are
• report to local providers, commissioners and planning and scrutiny bodies on their findings.

Overview and scrutiny committees should:

• act as a ‘bridge’ between politicians, professionals and the local community, so the voices of local people are heard and responded to
• consider whether new local policies and planned service changes will work in people’s best interests
• check on how these policies and change programmes are working in practice
• carry out proactive qualitative reviews to inform policies and services
• in doing so, ask Healthwatch and other community voice and patients’ organisations to help gather people’s views
• make recommendations to local organisations including the HWB, the council and NHS and ask them to respond to these recommendations.