Update on NHS IMPACT urges NHS leaders to adopt five practices for an improvement-led approach

NHS England has published a letter authored by the National Improvement Board chair and deputy chair David Fillingham and Professor Andy Hardy, sharing an update on the NHS IMPACT programme – designed to “promote the spread of continuous improvement throughout the NHS” – and sharing five practices to “form the DNA of an improvement culture”.

Addressed to national, regional, ICB and trust chairs, chief executives and directors, the letter states that an improvement-led approach can “can begin to make a positive contribution in the here and now to support a far-reaching transformation in the years to come”.

It specifies that NHS Impact is not a ‘one size fits all’ model, and adds that trusts and system should be encouraged to innovate and develop their own local approaches. However, the letter places emphasis on the need to consistently adopt five key practices: a shared purpose and vision to guide all improvement effort; investment in people and building an improvement-focused culture; leaders at every level who understand improvement and practise it in daily work; consistent use of an appropriate suite of improvement methods; and embedding improvement into management processes “so that it becomes the way in which we lead and run our organisations and systems”.

It goes on to explain how the NHS Impact team has co-designed a self-assessment tool and maturity matrix in these domains; HTN covered them previously here. The letter “strongly urges all boards and chief executives to engage directly with the self-assessment”, to undertake honest reflection on where the organisation currently stands, and to develop a plan from there.

To support the implementation of an improvement-based approach going forwards, the letter shares plans including a board-level competency framework and an engagement plan for regular networking, with more information to come over the next months.

In addition, it highlights plans to launch an NHS IMPACT bulletin after each meeting of the National Improvement Board, which will allow subscribers to keep up-to-date with headlines from discussion and recommended priorities.

As a final note, the letter urges NHS leaders to get in touch to share questions, reflections, best practice and areas in which support is needed. Comments and queries can be sent to

In July, HTN covered the first of the NHS Impact programmes to be launched as part of an “opportunity for systems and their providers to engage in a customised improvement programme”, with a focus on virtual wards, improved data use and standardisation.