Key points
- Lord Darzi's NHS Next Stage Review defines quality in three parts: clinical effectiveness, safety and patient experience. It urges the NHS to ensure that its focus on quality covers all three elements.
- Gathering better information on quality is at the centre of Lord Darzi’s vision for improving quality. In the NHS Next Stage Review he announced extensive plans to measure systematically and publish information about the quality of care on the front line. It is hoped this wealth of new data will allow patients to make informed choices about their care, allow clinicians to benchmark their practice and improve their performance, and allow commissioners to buy services based on quality.
- A national set of comparative quality measures or metrics – measuring things like mortality and survival as well as complication rates – will be developed across all services. The quality indicators for acute care are being developed at the moment and will be followed by similar indicators for community and primary care services. Data will also be available on ‘clinical dashboards’ – that is, simple, easily accessible graphic representations of the performance of a trust or department.
- New patient-reported outcome measures (PROMS) will provide detailed feedback from patients on their experience following a procedure, on measures ranging from mobility and pain to mental health and overall health. The first set of PROMS – covering hip and knee replacements, hernias and varicose veins – should be available in 2010.
- NHS trusts and provider organisations will in future be expected to publish annual ‘quality accounts’ similar to their financial accounts. These accounts are intended to improve public accountability and increase boards' focus on quality.
- Each strategic health authority (SHA) will develop Quality Observatories to allow local benchmarking and to help staff to use the information on quality to provide innovative and improved services.
- A National Quality Board will oversee the work of improving quality metrics and will advise the Secretary of State as well as reporting on progress on the quality agenda and leading change across the NHS. Its first annual quality report will be in June 2009.
- That patients will be able to choose based on information on quality is another lever for change. Under Darzi’s proposals patients will have a number of rights, including choice of GP, hospital and form of treatment, enshrined in the new NHS Constitution currently being considered by parliament as part of the Health Bill. It is hoped this increased consumer power – combined with other policies such as Payment by Results, where money follows the patient, and the availability of a wider range of providers – will complete the shift from centrally issued targets to market-style incentives that will automatically drive up quality.
- Commissioning is also critical to making the focus on quality a reality. The world class commissioning strategy, launched in December 2007, provides a means of measuring whether primary care trusts (PCTs) are delivering improved health outcomes for their population. It is overseen by the SHAs, whose role is to manage the performance of PCTs and ensure that the quality of care remains at the heart of commissioning decisions. The NHS Next Stage Review will also introduce new mechanisms to allow commissioners to reward for quality, such as the Commissioning for Quality and Innovation system (CQUIN) and the introduction of best practice tariffs.
- NICE (now the National Institute for Health and Clinical Excellence) has a new role in assuring quality. It will clarify, set and approve more independent quality standards and publish information for clinicians on these standards through a new service, NHS Evidence.
- The new independent Care Quality Commission, which began work on 1 April 2009, brings together three previous inspection bodies – the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. Improving quality as well as regulating for safety and ensuring minimum standards is a central part of its mission. It will have greater powers than its predecessors, including the right to close down organisations and make unannounced spot checks. And for the first time all health care as well as social care providers will have to be registered to ensure common standards of quality and safety.
- It is not clear how much the changes put forward in the Darzi reforms will cost and whether, given the economic recession and the probability of a much-reduced health care budget in future years, they will all be affordable. It may also be increasingly challenging for boards to focus on improving quality when under extreme financial pressure. However, an increased focus on quality does not necessarily mean increased costs. Indeed, much quality improvement could in fact improve productivity and save money.
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