How will Darzi deliver on patient expectations of the NHS?

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Niall Dickson, Chief Executive of The King's Fund, discusses public expectations of the NHS and how the Darzi review will attempt to meet them, for BBC Radio 4's Today Programme, 30 June 2008.

New Labour has long had a fear - that the middle class would desert the NHS; that the precious health service which Nye Bevan brought into the world 60 years ago this week would be reduced to a second class affair confined to those who couldn't afford anything better.

In part today's review is just a continuing response to this, hence the publication of a draft constitution for the NHS which will attempt to renew the bond between the people and the service.

But it is more than this. It is also an attempt - probably overdue - to respond to two revolutions: a revolution in expectations and a revolution in information.

Public expectations have already driven the government to spend billions more on the NHS in England and huge efforts have gone into cutting waiting times and providing us with thousands more doctors, nurses and other staff.

But we don't just want a bigger health service or a quicker one, we want a better one. Where our relatives are not in danger from hospital acquired infections, and where the surgeon's operating results are good. We want a service where staff are kind and don't lose our notes, and don’t keep asking the same questions. Where we get fed when we are hungry and given pain relief when we need it. That is what is meant by quality of care and today's report is expected to put that centre stage

The question is will it make any difference? After all, Lord Darzi aside, government ministers don't deliver health care and a series of diktats from Whitehall are unlikely to do the trick.

Indeed government enthusiasm for central targets has waned and the boast now is that control is being handed back to doctors and nurses.

Enter the second revolution: information. Over the next few years we will all begin to have access to data not just about the amount of care given by individual doctors and services but increasingly about the quality. New measures which will include patients' views on the outcome of treatment as well as their experience.

It is this information revolution that has the potential to drive up standards partly because it will allow regulators, managers and professionals to compare the performance of different services partly because it will enable patients to make informed choices.

Public expectations also demand a fairer health service. We have tolerated unexplained variations in quality and access since the NHS began but as information emerges we are less tolerant. Which brings us back to the constitution and the apparent promise to end the post code lottery with a right for every patient who needs them to have access to NICE approved drugs.

This however leaves an intriguing question: the government is in favour of encouraging local decisions yet it is also in favour of patients in one area not being disadvantaged when compared to another. There is an obvious tension here between wanting a universal service but not wanting a uniform one. The answer probably lies in enforcing basic standards for everyone, but allowing higher standards to develop in some services in some parts of the country.

Is this fair? Perhaps not, but as Bevan himself acknowledged, we will never be totally satisfied with what the NHS provides.


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