According to Lord Ara Darzi, who wrote a Comment in this week’s The Lancet, there is no quick and easy way to make the National Health Service fairer, more responsive, safer and more effective. Lord Darzi is from the UK Department of Health and was the lead author of a recent report into practice within the National Health Service (NHS) in England.

Fairness

In this present article (Comment) Lord Darzi covers each of the four areas in detail, starting with Fairness. Darzi explains that as the NHS is free at the point of need, it is fair. However, areas with the greatest need for doctors have the lowest density of them (lowest number of them per head) – this imbalance urgently needs to be dealt with, he writes.

Responsiveness

Lord Darzi explains that the NHS could be a lot better if it were to pay attention to people’s comments more. He gives two examples, most people would prefer to die at home but only 20% of them manage to do so; the late evening/Saturday opening of general practices.

Safety

Darzi compares Denmark to the UK. In Denmark only 1% of Staphylococcus aureus infections in are meticillin-resistant, while in the UK the figure is 44%. He believes there should be a local focus on hygiene throughout the NHS.

Effectiveness

“Too often the NHS is not an early adoptor of new techniques and approaches. Healthcare for London: a framework for action highlighted how in England we are lagging behind international best practice in interventional stroke care…I will lead a Health Innovation Council to ensure leading-edge treatments are available to all on the NHS,” Darzi writes.

Darzi concludes that most of the answers to improving quality of care will need to be worked out locally through specialist health authorities, considering the available evidence and sharing ideas with patients and employees.

“By combining a national perspective with local knowledge and experience, the Our NHS, our future review can prove that we are not missing the obvious, and that we recognize good-quality care is absolutely fundamental to the NHS,” Darzi adds.

Editorial

An Editorial wonders whether the current general practice model is the optimum way for the NHS to deliver primary care services. “In an era when medicine is becoming ever more specialized (in terms of doctors knowledge and expertise, and the organization of services), how sustainable is a system of general practice based on minimal training in key specialties, and resulting in uncertain performance?” the author writes.

The author urges specialists to take their skills into the community to improve patient care, reduce waiting times and avoid inappropriate referrals to secondary care.

The Editorial calls on specialists to realize that taking their skills into the community could improve patient care, reduce waiting times and avoid inappropriate referrals to secondary care.

“For too long, and despite endless attempts at reform, the NHS has been complacent. Based on a model of care that is 50 years out of date, it is led by sometimes narrow professional and political interests in the absence of evidence about service design. A 21st century health system needs the most skilled doctors working alongside general practitioners in the community, as well as specialist hospitals. Yet this is the change in the NHS that few dare suggest,” the author concludes.

“What next for the NHS?”
A Darzi
The LancetVolume 370 • Number 9596 • October 20 – 26, 2007
http://www.thelancet.com

Written by: Christian Nordqvist