Lancet strongly supports Darzi's focus on NHS quality, engagement and professionalism

June 30, 2008

The Lancet strongly supports Ara Darzi's focus on quality, engagement, and professionalism in the NHS Next Stage Review released today by the Department of Health. In a Comment published early Online to coincide with the publication today of Lord's Darzi's final report, Lancet Editor Dr Richard Horton says that for doctor it feels that, at long last, their call for clinical leadership in policy making has been heeded. It is now up to the profession to take this exceptional opportunity and make it work for patients

He says: "Darzi has wisely thrown out regulation as the organising principle of the NHS. He has replaced it with quality, by which he means clinical effectiveness, patient safety, and the patient experience…This cultural shift is a radical re-visioning of purpose for the NHS -- away from the political command and control of processes and towards professional responsibility for clinical outcomes."

Dr Horton also praises Darzi's drive on enhanced patient engagement, referring to the new NHS Constitution giving patients legally enforceable rights; improved access to their own health information; new guaranteed access to NICE approved drugs on the NHS; and improved opportunities for feedback.

The Lancet especially welcomes Darzi's focus on professionalism: "The benefit for patients is an NHS where priorities and plans are determined according to clinical need and knowledge. The benefits for doctors are greater freedom and control over the future of the health system -- strategy, budgets, and staffing. But doctors have to be prepared to change -- to stop defending old professional boundaries (eg, between primary and secondary care) and to accept that what they might believe and say is quality care may actually hide sometimes fatal service weaknesses."

The journal agrees with Darzi's assertion that research has a key part to play in making these proposals a reality: "Continuous inquiry brings continuous improvement." Importantly, Dr Horton notes that all the measures in Darzi's report will be independently and scientifically assessed moving forward. And relating to NHS staff, Dr Horton says: "Finally, proper attention will be paid to the people who make the NHS what it is -- its staff. Instead of being criticised, blamed, and threatened, NHS professionals will be consulted more, receive better training (with funding following the trainee), undergo leadership development in the undergraduate and postgraduate years, and have more attention given to their health and wellbeing."

Dr Horton concludes: "[Darzi] is writing as one health professional to other health professionals, as well as to the public. His achievement should not be underestimated. He has managed to engineer a major shift in government policy, language, and tone. He has revised the role of the Department of Health to one of setting values, principals, standards, and rights. He has also revived the part professionals can play in leading NHS quality improvements."


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