Daily Insight: A quality appointment?

Lord Ara Darzi’s last major review for government landed in summer 2008, close to the apex of record low waits for NHS healthcare, which were driven by more than half a decade of steep growth in funding and staffing; a stiff targets regime with lots of managerial welly behind it; and pretty clear plans and incentives. 

His answer to “what’s next” was, in simplified form: the NHS needs a much more rounded view of care quality; more measurement, transparency, and improvement of it; and to re-engage clinicians — especially medics — in leading.

This week, in stark contrast, the eminent-surgeon-cum-academic-cum-innovator-cum-Parliamentarian-cum-policymaker has been tasked with carrying out an “independent investigation” (“independent of what?” you might ask) of why NHS performance is now plumbing previously unknown depths after 14 years of stagnation and decline.

These very different circumstances have not stopped Lord Darzi from digging out the old 2008-era mantra, saying in the announcement of his review that he wanted to put care quality back in its rightful place as “the organising principle of the NHS”.

While times have changed, that still seems like a good idea, and the NHS has certainly lost its way on care quality. The regulator’s in a right mess, with many NHS trusts’ ratings never getting better despite obvious failures. Industrial disputes have fractured clinical/management relationships. The ultimate outcome indicators — mortality, life expectancy, and healthy life expectancy — have been wobbling, with authorities slow to take any interest or offer explanations.

Some key outcome, process and experience measures are in the doldrums, though many are still hidden or hard to track. The NHS outcomes framework — put in place in response to Lord Darzi’s work to define and measure quality by the then new NHS medical director Sir Bruce Keogh — has been allowed to go by the wayside.

Many initiatives to improve measurement — such as better capturing experience, preventive interventions, value, and patient-reported outcomes — have been on go-slow or wilted altogether. This time, Lord Darzi’s only got until September to report. His political purpose is obvious: to quickly ram home the message of just how badly the NHS was broken when Labour picked it up and the enormous scale of the job to fix it.

But if Lord Darzi can also use his rapid review to install “quality” at the heart of Labour’s recovery and 10-year reform endeavours, it will be a job well done.

Ready, steady, wait

Patients wait more than two weeks to be discharged from hospital after they are deemed “ready” to leave at some trusts, according to new NHS England data.

HSJ analysis of a newly published NHSE metric has found four trusts where patients waited 14 days or more from when they were “discharge ready” to when they actually left hospital.

That was more than double the six-day average discharge delay across English acute hospitals.

NHSE has made reducing delayed discharges a key priority in the national urgent and emergency care recovery plan.

Delayed discharges are often the result of social care shortages, but previous HSJ analysis has shown as much as a third of the delays are due to predominantly NHS-related factors.

The trusts with the longest delays said they were working with systems and relatives to discharge patients faster.