The NHS 60 years on - High Quality Care for All?

30 June 2008 - Features Editor

Darzi report High Quality Care for All published with emphasis on the quality of care, backed up by a draft NHS Constitution.

The 60th Anniversary of Britain's National Health Service (NHS), established on 5th July 1948, is an appropriate occasion for marking its achievements while looking ahead to the future of the nation's favourite institution.

Starting with the founding principle that, "good healthcare should be available to all regardless of wealth" until today's consensus among taxpayers that the government has and continues to pump financial resources into the NHS without significantly delivering on patients' expectations, there has been intense public debate about getting value for money. Now, as the debate gathers pace in earnest, another review of the NHS after12 months of deliberations, concludes with radical proposals for the next ten years.

Darzi's review places quality of care first, while everything else is way down the list of priorities as all the proposed changes aim to raise standards. This does not get away from the recurrent griping about a bureacratic, centrally controlled organisation prescribing top-down targets.

Doctors and hospitals are to be measured according to the quality of care they deliver, and rewarded accordingly, for example, how many patients die. Patients will be asked for their opinion while other more specific outcome measures will determine just how good their care really has been.

So, after 60 years, the NHS has finally signalled the end of a free-for-all, of delivering cheap healthcare but costing the taxpayer an arm and a leg, while leaving its 'customers' (its patients) largely dissatisfied.

Here at AiLS it is a point of principle, assimilated from the lifescience sector for more than the last 35 years, that the manufacturing services for medicines, diagnostics and medical devices are wedded to the concept that the customer is king and, as such, deserves a service that is fast, delivers value for money and of the best quality in a highly competitive marketplace. Lord Darzi's review, welcome as it is, shows the NHS as being 35 years behind the times in its 60-year long history.

In publishing the findings of his 12-month review of NHS services, Lord Darzi of Denham proposed that doctors and patients would have a greater say over the performance of the NHS. His report is released along with a milestone, a new NHS constitution, which aims to grant patients a legal right to choose where they are treated and to receive approved medicines where clinically appropriate.

Lord Darzi, became the Minister for Health after being appointed by Prime Minister Gordon Brown last year, with the brief to reform the NHS in its 60th year. The review, weighing in at 84-pages, is the deliverable end-product of a process that took on board the opinions of 60,000 people and 2,000 medical experts.

Darzi's report High Quality Care for All does not make any specific recommendation about anticipated changes to local health services, for example, the introduction of 150 new polyclinics or GP-led health centres, nor even the consolidation of hospital units, which many fear could lead to the loss of essential, local services. Instead, his report, "is designed to enable local changes" already proposed among the ten regional NHS strategic health authorities over the past few months.

The draft NHS Constitution

The draft NHS Constitution published on 30th June 2008 is a 6-page document that sets out new, legally-enforceable rights and pledges for patients and health service staff. They include:

Rights for patients

to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament
to access local NHS services and not be refused access on unreasonable grounds
to expect your local NHS to assess the health requirements of the local community and to put in place the services to meet those needs as considered necessary.
to seek treatment elsewhere in Europe if you are entitled to NHS treatment but you face undue delay in receiving that treatment.
to drugs and treatments that have been recommended for use in the NHS, if your doctor says they are clinically appropriate for you.
to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. (If the local NHS decides not to fund a treatment that the patient and doctor feel would be appropriate, then they will explain that decision to the patient.)

Pledges include:

The NHS will strive to make decisions in a clear and transparent way, so that patients and the public can understand how services are planned and delivered.
The NHS will strive to make the transition as smooth as possible when you are referred between services, and to include you in relevant discussions.
The NHS will strive to ensure that services are provided in a clean and safe environment that is fit for purpose, based on national best practice.
The NHS will strive for continuous improvement in the quality of services you receive, identifying and sharing best practice in quality of care and treatments.
The document also outlines seven "key principles that guide the NHS"; including that it provide "a comprehensive service, available to all", "aspires to high standards of excellence", and that it "must reflect the needs and preferences of patients, their families and their carers".

Hospitals and family doctors may be fined, or financially rewarded, depending on what patients think of the quality of their care. For the first time in the 60-year history of the NHS, opinions by patients on the results of their treatment, and also whether they were cared for with dignity and compassion, will have a direct impact on the income of NHS organisations.

Related articles:

Darzi Report Welcomed by UK's Pharma Industry

Should NICE have the same power as drug licensing authorities?

Keywords : UK, National Health Service (NHS), 60 years anniversary, Lord Darzi, Minister for Health, Review, Report, High Quality Care for All, NHS draft Constitution, Rights for patients, Pledges, Penalties and rewards, Quality targets for NHS organisations

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