If the NHS is to improve the quality of care it provides, its leaders need to work in partnership with patients to give them the information and skills to understand how to best manage their condition.

The expectations of the Darzi review are running high. Like many others, the Health Foundation contributed its views to Our NHS, Our Future in January and we now await the final report.

Which outcomes do we hope to see? We strongly believe that what most people want is a system of care that is delivered safely and effectively in the most humane way. They want to see a true partnership between patients and clinicians, supported by managers who have an interest in the outcomes of care for patients and take an interest in working alongside clinical staff to remove the barriers to high-quality care.

A healthcare quality study conducted by Elizabeth McGlynn at theRAND research organisation in theUSshowed that only 55 per cent of care provided is effective. If we could reliably deliver care we know to be effective, we could improve the health of many people.

Challenges ahead

The major challenge for the Darzi review and the NHS is to make sure every patient receives the highest quality of care, every time. Here are some steps we think will help Lord Darzi rise to this challenge.

There are currently 17 million people in theUKliving with a long-term condition. This number will continue to rise as life expectancy increases.

We are looking to Lord Darzi's final report to promote patients as active partners in care and seek to design and organise care around patients so they can play a more active role in their own healthcare, not just in choosing the service they wish to access.

Patients need information and skills to understand how best to manage their condition. There is little investment being made in these areas, including methods by which clinical staff can learn how best to provide support to patients.

Making care safer, more effective and more responsive requires the will to act, a focus on measuring outcomes for patients and attention to the processes of care. This cannot happen without supporting and developing the workforce.

Many clinicians have learned how difficult it is to change the way care is provided. Some of these experiences are very disempowering, but there are also people whose energy and commitment can enable them to provide leadership to others in making changes that matter to patient care.

Lord Darzi's final report could provide the building blocks needed to support the development of these leaders.

Continuous improvement

If we want to improve the quality of care, it is vital that we build the will of clinicians and managers by celebrating the best role models and funding centres of excellence in systematic quality improvement in the NHS.This will not be achieved unless Lord Darzi's vision for the future of the NHS also provides education and training in the tools and techniques to improve quality of care.

Leadership focused on how to improve the quality of care needs to be reflected in the decision making of those at the top, as well as being a core responsibility of boards of providers and commissioners.To help this change, we would support using the NHS performance management system and regulatory framework to ensure providers have explicit and applied strategies for systematically improving quality.

Finally, to improve quality of care we need to place measurement at the heart of systems of care for improvement at local level, including through the widespread collection and use of patient-reported outcomes and promoting the use of clinical outcomes to build personal accountability for care.

We firmly believe that all of these measures are necessary to create an overarching system to improve quality in the NHS. This system is essential if we are to move from a health service where patients do not always receive the most effective and timely treatment to an NHS that has systems in place to deliver effective care reliably.

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