04 July 2008
NHS managers have welcomed moves to link a proportion of trust income to patient satisfaction but are calling for organisations to be judged fairly.
High quality care for all, the final report of cancer surgeon and health minister Lord Ara Darzi's review of the NHS, was published on June 30. It recommended that quality be the organising principle of the health service and that patient satisfaction be given a much higher priority.
For the first time, care quality and treatment outcomes across the NHS will be measured and the results published. Organisations that demonstrate high levels of patient satisfaction will be given more money.
NHS chief executive David Nicholson said that between £7m and £9m of an average district general hospital's income would depend on demonstrating top-quality clinical performance.
But NHS Confederation policy director Nigel Edwards said that while 'the general principle is probably right', there were questions over how such a system would work in practice.
Would trusts be rewarded by how much they had improved or for their performance relative to other trusts, he asked.
'It's tricky because most satisfaction measures run quite high, so to get significant improvement measurements you need quite big samples,' he told Public Finance.
The alternative, of cross-sectional comparisons – which compare performance across trusts – was problematic because of local population characteristics, he added.
'Work done by [pollsters] Mori shows that trusts that service areas which are ethnically diverse seem to have more difficulty producing good scores.'
Overall, the confederation was positive about Darzi's report, saying it contained most things NHS leaders have said they wanted. Darzi proposed a shift in emphasis from top-down targets, giving more responsibility to staff at the local level.
'This report will enable frontline doctors, nurses and patients – who provide and use NHS services – to put into practice their visions for high-quality care,' said Darzi.
Underpinning the changes is an NHS constitution setting out the rights and responsibilities of staff and patients.
Patients will have a legal right to choose their GP and will be able to express a preference for a hospital consultant.
There will also be a new right to drugs that have been approved by the National Institute for Health and Clinical Excellence, which will be expected to make quicker and more transparent decisions.
British Medical Association chair Hamish Meldrum said the success of Darzi's proposals would depend on the details and the engagement of NHS staff.
But health think-tank the King's Fund criticised Darzi for his failure to address costs. Chief executive Niall Dickson said: 'There are no estimates of how much all this will cost and no indication of just how different the government expects the quality of health services to be in five or ten years time.'
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