All aboard?

3 Jul 08
MIKE THATCHER | Like buses, NHS reforms tend to come in fits and starts. We haven’t had any for a while, but this week – to coincide with the NHS birthday bash – three came along at once.

Like buses, NHS reforms tend to come in fits and starts. We haven’t had any for a while, but this week – to coincide with the NHS birthday bash – three came along at once.

Lord Darzi’s Next stage report was published alongside plans for an NHS constitution and a new workforce strategy. All in all, a ten-year plan that the PM described portentously as a ‘once-in-a-generation opportunity’.

It is, of course, nothing of the sort. Darzi’s review is no Beveridge or even Wanless report. More a direction-of-travel, Satnav kind of document – designed to build bridges with beleaguered health professionals and a cynical public.

Its leitmotif, appropriately for cash-strapped times, is quality not quantity. Quality care, measured by quality accounts, will be overseen by a new National Quality Board.

Hospitals and surgeries will be obliged to display ‘clinical dashboards’ showing their progress – rather like those digital displays at bus stops. It is, says Lord Darzi, the next stage of the reform journey, and the aim is to give patients ‘more clout’.

This will be done by pegging trust budgets to levels of patient satisfaction: a measure that could be worth 3% of a hospital’s income by 2010.

Darzi’s proposals have received a cautious welcome from health managers, particularly for their refreshing lack of new targets or masterplans. But there is some consternation at the absence of costings in his 84-page report.

The NHS already accounts for almost 8% of GDP and is due to double that percentage within 50 years (see cover feature on pages 16–19). So why are there no estimates of what all this improved quality care will cost?

Nor is it clear how the new outcomes will be measured. As the NHS Confederation points out, calculating the size and type of samples needed to compare satisfaction outcomes is no easy task.

Trusts could be landed with a whole new set of comparators that – like so many previous measures – distort clinical priorities.

But these are mere details, to be addressed in an operating framework this autumn. The real difficulty with Darzi’s route map will be getting practitioners and public on board. And that really could be a once-in-a-term opportunity.

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