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What Next For The NHS?

Improving the fairness, responsiveness, safety, and effectiveness of the care provided by the UK National Health Service (NHS) in England is a continuous process with no quick fix, concludes Lord Ara Darzi, author of a comment in this week’s edition of the Lancet. Lord Darzi, from the UK Department of Health, was the also the lead author of a recent report into practice within the NHS in England.

In the Comment, Lord Darzi looks at each of the four areas above in detail, beginning with Fairness. He says that while the NHS leads the way in being free at the point of need, the areas with the greatest need for doctors have the fewest number of them per head, an imbalance which needs to be addressed.

On responsiveness, Lord Darzi says the NHS in England could be improved if it listened more to people, for example regarding late evening/Saturday opening of general practices, and the fact that more than half the population want to die at home, but less than a fifth of deaths take place there.

For safety, the Comment looks at the concerns on health-care associated infections. It says: “Although only 1% of Staphylococcus aureus infections in Denmark are meticillin-resistant, the proportion in the UK in 44%.” And while the Darzi review said that bacteriological screening of elective and emergency admissions for MRSA should help tackle health-care associated infections, there also needs to be a local focus on cleanliness across the NHS.”

On effectiveness, Lord Darzi concedes: “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.”

The Comment concludes by saying that most of the solutions to improving quality of care will need to be worked out locally through specialist health authorities, considering the best available evidence and sharing ideas with patients, the public, and staff.

It says: “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 recognise good-quality care is absolutely fundamental to the NHS.”

A related Editorial asks whether the existing model of general practice is the best way for the NHS to deliver primary care services. It says: “In an era when medicine is becoming ever more specialised (in terms of doctors knowledge and expertise, and the organisation of services), how sustainable is a system of general practice based on minimal training in key specialties, and resulting in uncertain performance?”

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

It concludes: “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.”

Tony Kirby | alfa
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