Feature Quality of Care

Measuring up the NHS

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b703 (Published 25 February 2009) Cite this as: BMJ 2009;338:b703
  1. Nigel Hawkes, freelance journalist
  1. 1London

    Few would argue with Ara Darzi’s vision of high quality care for all but agreeing on how to assess it is much more difficult, Nigel Hawkes reports


    For the NHS, quality is the crock of gold that lies at the end of the rainbow. Somehow it is always just over the horizon: an aspiration frequently articulated but never quite realised. Writing in the BMJ in 1988,1 George Godber remarked of the NHS: “It still does not have inbuilt review of quality.” When the former chief medical officer died earlier this month at the age of 100, his judgment remained largely true.

    Quality has repeatedly been promised. In Frank Dobson’s 1997 white paper The New NHS: Modern, Dependable, we were told: “The new NHS will have quality at its heart . . . Every patient who is treated in the NHS wants to know that they can rely on receiving high quality care when they need it. Every part of the NHS, and everyone who works in it, should take responsibility for working to improve quality.” And so on, and so on.2 But this was also the white paper that abolished the (now reinvented) internal market, so perhaps we should not linger too long over it.

    The quest for quality resumed last year with the Darzi next stage review. High Quality Care for All3 made the Q word the central defining issue for the NHS, calling for trusts to produce annual “quality accounts,” and linking the tariff to quality of care for the first time, under a new commissioning for quality and innovation framework.

    What determines quality?

    But if quality is to be rewarded, it must be measured. So the Department of Health, through the Information Centre, launched a consultation into the best ways of measuring it. Doctors, nurses, …

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