Key points

• Good-quality health-care makes a large contribution to public health, both by increasing life expectancy and improving quality of life.

• Quality can be defined; it is multidimensional. The different dimensions of quality can be measured, but some (e.g. clinical effectiveness) are easier to measure than others (e.g. professionals’ empathy for patients).

• Problems with quality of care are widespread, with many people either not receiving effective health-care, or receiving care that is ineffective or harmful.

• Evaluation of an intervention attempts to determine objectively whether the activity in question is meeting its objectives.

• Assessing the impact of public health interventions in the short term can present particular challenges.

• Clinical governance refers to the systems through which NHS organisations and staff are accountable for the quality of patient care.

Introduction

As we saw in the introductory chapter, effective health-care makes a large and increasing contribution to preventing disease and prolonging life, by reducing the population burden of disease. However, only the right kind of health-care can improve health. Health-care interventions that are powerful enough to improve population health are also powerful enough to cause harm if incorrectly used. The last part of the planning cycle to which you were introduced in Chapter 6 concerns evaluation. How can public health specialists know whether their interventions are having the desired effect? Clinicians can monitor the impact of their treatments on an individual patient basis but how do we examine the impact of a new service? In this chapter, we will look at what we mean by quality of care and consider one well-known framework for its evaluation. We will consider ways in which quality of care is promoted across the NHS.