Darzi review: Reward hospitals for improving quality, Lord Darzi says
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a642 (Published 01 July 2008) Cite this as: BMJ 2008;337:a642
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The Darzi Review. Yet again politicians are meddling, trying to tell
us what sort of health service we are to receive.
Including charges, the NHS in England now costs £100bn. That is £2000
pppa is being spent on the NHS. An amount 50% more than we spend on our
biggest item of household expenditure, transport and double our
expenditure on food and drink.1
Our health expenditure on the NHS is comparable with European
countries and yet there has not been a commensurate increase in output,
nor are our health outcomes comparable and complaints about the NHS
continue. The expected improvements have not been achieved. Now, it is
suggested that the NHS needs more money! That would be good money after
bad.
The NHS is seen by some as the Black Hole of public expenditure
gobbling up more and more money, when other items of expenditure such as
the Bristol Channel barrage at about £15bn over a ten year build and the
high-speed link to Scotland could be funded by a small part of NHS
expenditure. How long can the current organisation of the NHS continue?
Will the Darzi Report save our “equitable care funded by central taxation
and free at the point of need” NHS 2. I do not think so.
The government claim that they are setting no more targets in the
NHS, but most managers who are told that quality is a priority would see
that as a directive and it becomes another target.
There are too many different services providing for a very large
variety of needs for politicians to decide what the best health service
for patients is. The NHS is a "politically controlled state monopoly that
is inefficient, outdated, and unsustainable,"3 with shades of British
Telecom in the 1970s: a poor, limited and expensive service, which we had
to take since we had no other choice, unable to increase efficiency and
respond to the needs of customers.
If the NHS is to continue to be tax funded, then politicians have to
be involved, but patients’ influence can be increased and politician’s
involvement reduced. If those responsible for commissioning care, the
PCTs, were allowed to compete for patients and patients could choose from
a selction of PCTs the package of care they preferred, then there would be
incentives for PCTs to look for more efficient ways of using resources and
provide services that are more sensitive to the needs of patients 4, 5.
Politicians would retain only decisions about the levels of capitations
and possibly, what minimum audited data set of information the PCTs should
provide to enable patients to decide which PCT should be responsible for
spending their capitation allocation.
Then the NHS could continue to provide equitable care, funded by
taxation and free at the point of need and patients would get the service
they want and deserve.
References
1 Ed Dunn Family Spending, 2007, Office for National Statistics
http://www.statistics.gov.uk/downloads/theme_social/Family_Spending_2006-
07/FamilySpending2007_web.pdf
2 Fiona Godlee, (2008) Editor’s Choice: The NHS in our hands. BMJ
2008;337:a663
3 Luke Johnson in Rebecca Coombes, 2008, NHS Anniversary
The NHS debate, doi:10.1136/bmj.a628, BMJ 2008;337:a628
4 David Allen (2007) A Rational Way Forward for the NHS: bmj.com, 15
May 2007
http://bmj.bmjjournals.com/cgi/content/full/334/7601/969?ck=nck
5 David Allen (2007) Re: What lessons are there for the UK and the
NHS from Professor Reinhardt article? bmj.com,
www.bmj.com/cgi/content/extract/334/7599/881
Competing interests:
None declared
Competing interests: No competing interests
darzi report preventive medicine
It is amazing that so llittle mention is made of
preventive medicine in the Darzi report.
A very important part of the GPs work consists of
health education and giving inoculations. The former,for example, has helped to achieve the remarkable
reduction in lung cancer deaths and the great
reduction in infantileand child mortalkity.
Deaths from many infectious diseases have been
greatly reduced, or even eliiminated, as in the case of
poliomyelitis, by inoculations. In all these programs, and in daily advice on health
matters.the general practitioners have played a great
part.
This role should be widely recognised and the GPs
encouraged and helped to do even more preventive
work.
Competing interests:
None declared
Competing interests: No competing interests