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National Health Service History

Interview with Lord Darzi in April 2009 at Wharton College, University of Pennsylvania.

I had the privilege of designing where we are heading for the next phase of our reform, which I articulated in my report last July. [It contains] a very clear statement: "Quality will be the organizing principle of the NHS." First, because it's a health care system that looks after you from cradle to the grave, it should start with and we are investing in prevention. Prevention is better than cure. Prevention is cheaper than treating illness. Many of our interventions are: "How do we introduce evidence-based measures in prevention?" whether these happen to be life style based diseases or others. I'll give you obesity as a good example. We look at obesity as seriously as climate change, because we believe, from a health perspective, that it could have the biggest impact on the health of our population.

The second thing is quality. It's like many other sectors. Let's not forget that quality may be cheaper in health care. Quality's not more expensive. It may be cheaper. Doing things right the first time, giving patients access at an earlier stage of their disease that in itself will make health care costs cheaper. So on the one hand, I'm reassured because we have a universal health care, which is tax funded.

To do that requires a mindset change, a behavioural change, across the system. That is the type of transformational change that we are thinking of at the moment. More importantly is what we've learned from the next stage review, which I led. There were 10 regional reports. Clinicians felt that they were actually involved, challenging themselves with evidence-based care, and designing the pathways of care. So there was ownership in that process.

Besides the ownership, we need to move on to the next phase, in which they feel empowered to make that change happen. I think what's important for us, as clinicians and I will say "us," me, too is that when you are empowered, accountability comes with it. I think, for the first time, and certainly in this phase of reform, it's not just individual accountability; it's a collective accountability around the team looking after a patient.

I'll give you an example. If you look at a patient pathway, from the day they are referred from their primary care physician into a hospital setting treatment is done in hospitals by multiple teams then back to the primary care physician, we need a way in which there is a collective accountability across the pathway of care. That is what we need to work on and develop within the NHS, and that's exactly what we're doing. I announced in my report what I call the National Leadership Council, which is the opportunity for the NHS itself to develop and promote leadership skills within that accountability framework that I described.

I believe what I would like to be said is [that I] focused our minds on what matters most with quality being the organizing principle of any health care system. It is quality that wakes me up in the morning to come to work, it is quality that my patients expect from me.