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Robina Shah on speaking Darzi's language

Nelson Mandela once said: 'If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart.'

Lord Darzi's long-awaited review of the NHS speaks the language of quality and patient experience. However, whether it captures the mind or the heart will depend on how this language is embraced by the NHS family.

Lord Darzi's report, High Quality Care for All, is dynamic; it is grounded in the patient experience; and it offers great potential to deliver an inclusive, high-quality, personal health service. Achieving this will be challenging though.

In the report, Lord Darzi highlights the patient experience as the "most powerful lever which will be used for service improvement". He emphasises that the report is about quality, and that this is what energises staff in the NHS. Hence, from April 2010 all NHS providers will be legally obliged to publish "quality accounts" on safety, patient experience and clinical outcomes in the same way they publish financial accounts.

The intention is good, but how will trusts turn this into something that can be measured? Are we confident we will be able to provide robust, meaningful data in all these domains? While it is good news to hear that target-driven health policies are to be toned down, there is genuine concern about how data on quality will be collected and published among more objective measures of safety and clinical quality.

Outcome focused

Furthermore, in addition to the payment by results system, funding to hospitals will depend on quality of care as well as volume. Hospitals and general practices that perform best will receive extra funding. For example, organisations scoring highest on indicators such as rates of infection, clinical outcomes and patient satisfaction will be paid more than those with lower scores.

This is where the detail in the report is lacking and as such presents one of the greatest challenges to us all - creating an agreed quality assurance system that provides coherence and fairness when assessing data quality. The language of accountability based on patient-reported outcomes is the glue that binds quality and safety. However, language alone will not be enough to drive the change and investment needed to sustain a patient-centred NHS.

Sophisticated information networks and agreed national metrics will be needed to support the drive to improve quality across the NHS. This will involve proactive leadership, collaboration, and engagement with patients, clinicians, managers and the public as part of the government's choice agenda.

Going strong

The NHS will deliver a better, safer, more holistic and quality-driven integrated health and social care service. It will embrace its partners in the third sector and it will work with all its stakeholders, not because it has to but because it wants to.

Sixty years after its creation, the NHS continues to thrive. It touches our lives at times of basic human need, when care, respect and compassion are what matters most. The Darzi report is to be welcomed as a key facilitator in delivering just this.

Readers' comments (1)

  • Readers might be interested in an article in the BMJ by an American author
    "The first principle of the Toyota way, one of the world’s most successful management systems, is to base decisions on a long term philosophy that generates value for the individual, society, and the economy"
    "Beyond affirming a solid, long term philosophy, however, the final report of the NHS next stage review does not reflect the 14 principles of "the Toyota way" to manage an efficient and successful healthcare system. Three of its principles, for example, involve thoroughly discussing and considering all sides of a change before introducing it. Careful testing and visible measures of performance must be combined with a culture devoted to identifying problems, analysing their causes, and tackling them before proceeding further, not unlike good clinical medicine."
    "Instead, the NHS strategic plan begins with an eight page summary letter from Lord Darzi that proposes 33 changes in three loosely constructed clusters.Additional changes appear in the three core chapters on quality, but none of them to my knowledge has been carefully considered from all angles or thoroughly tested."
    Well worth reading.- as is the next article, also an American point of view.

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