Under Lord Darzi's recently published plans for the health service, clinicians will lead the charge to top-quality care. Ingrid Torjesen explains

Lord Darzi's long-awaited review of the NHS is focused on driving up the quality of care through the empowerment and leadership of clinicians.

Existing top-down targets will become minimum standards and quality will be ratcheted up through quality frameworks, first in acute and then in community services. Like the general practice quality and outcomes framework, these frameworks will specify clear standards and care provided will be measured against them. Achievements will be published to help understand variations in quality and best practice, and quality care will be rewarded to encourage further improvements.

Lord Darzi hopes to make providing quality care "an obsession within the NHS". "In my experience, providing high-quality care leads to professional pride, and focusing on improving it energises and motivates all NHS staff, clinical and non-clinical alike," he says.

He argues that change is most effective when it responds to patient needs and is driven by clinicians, which means empowering clinicians and strengthening the role of clinical leadership.

Stepping up

In the past, most clinicians tended to be confined to their role as practitioners, but Lord Darzi's final report High Quality Care For All reveals that in the future clinicians will have the opportunity to be partners and leaders as well.

As partners, clinicians will have individual and collective accountability for the performance of the health service and for the appropriate use of finite resources in the delivery of care. They will work closely with others within and outside the health service, such as in social care and schools.

As leaders, clinicians will be expected to offer leadership and, where they have appropriate skills, take senior leadership and management posts in research, education and service delivery. Formal leadership positions will be at a variety of levels, from clinical teams, to service lines and departments, to organisations and ultimately the whole NHS.

"Acknowledging clinicians' roles as partners and leaders gives them the opportunity to focus on improving not just the quality of care they provide as individuals but within their organisation and the whole NHS," the report says.

Lord Darzi acknowledges that the NHS must change to create the right environment for clinicians to work as partners and leaders alongside their manager colleagues.

Devolving power

Creating the right environment involves giving clinicians at the front line more freedoms, both as providers and commissioners, to use their expertise to find innovative ways to improve care. To achieve this, the process by which NHS trusts achieve foundations status will be speeded up, community services will be allowed foundation status for the first time, social enterprises will be encouraged, and a wider range of clinicians will be encouraged to become involved in practice-based commissioning.

Rather than being accountable to central targets, NHS services will be accountable to the patients and communities they serve and their peers as a result of publication of their quality outcomes. Lord Darzi believes this transparency on clinical outcomes will facilitate meaningful conversations between teams on how they can continuously improve the quality of care they deliver.

"If clinicians are to be held to account for the quality outcomes of the care that they deliver, then they can reasonably expect that they will have the powers to affect those outcomes. This means they must be empowered to set the direction for the services they deliver, to make decisions on resources, and to make decisions on people," he says in his report.

"In acute care, giving nurse managers authority and control over resources will lead to better, safer, cleaner wards and a higher-quality patient experience. Giving clinical directors the power to make decisions on the services they offer, the appraisal and management of their staff and the way in which they spend their budgets will lead to better-quality outcomes for patients."

The Department of Health pledges to support clinicians as they take on these roles through its new 'leadership for quality' approach.