Lord Darzi's report (Department of Health 2008) attempts to open a new chapter in the story of 'quality' in the English NHS.
How does the English NHS move on from a centrally driven performance management regime – with its focus on driving activity and meeting targets – to a more sophisticated strategy? One that will also strengthen the capability and capacity of local NHS leaders to deliver higher quality – and more effective – patient care.
Behind the review lie two vital devices to drive up standards: more and better information about clinical performance and a strengthening of existing incentives.
In addition, a draft constitution for the NHS was published which, among other things, enshrines the right of patients to choose where and how they are treated.
This report could bring a radical change in what the NHS delivers in England and how it delivers it. It opens up a vision of a service in which quality improvement is driven by local clinicians, armed with better data on the effectiveness of their own work, spurred on by financial incentives and by the choices of well-informed patients rather than by top-down targets.
However, it is a vision that has to be classed as 'potential' rather than real because of uncertainty about how it will be implemented: has the centrally driven reform agenda been adapted enough to let locally led change thrive?
Are the resources there to innovate and support the necessary changes in information-gathering? Will patients understand the information and be persuaded to act on it? And, above all, will local NHS staff drive improvement on a big enough scale and be as enthusiastic as the 2,000 clinicians and other staff who fed their views into the review?
This briefing provides The King's Fund's analysis of the key themes explored in the review.