Darzi's review of quality of care in the NHS

doi:10.1136/bmj.39541.622917.80

BMJ 2008;336:844-845 (19 April), doi:10.1136/bmj.39541.622917.80

Editorials

Darzi’s review of quality of care in the NHS

Should focus on how to motivate institutions as much as whatgood quality care looks like

The first 150 words of the full text of this article appear below.

In 2002, a bitter argument raged in the letters pages of theBMJ. It followed the publication of a study by Feachem and colleaguescomparing an American managed care organisation, Kaiser Permanente(North California), and the NHS.¹ The NHS fared less well onseveral indicators of effectiveness and efficiency of care.Feachem and colleagues (and others) concluded that a combinationof competition, better information systems, and other incentives—notjust level of funding—explained Kaiser’s betterperformance.¹ The study was quickly attacked on methodologicaland ideological grounds.²

Intrigued like many others, a group at the King’s Fundlooked more closely at the care provided for people with longterm conditions at Kaiser and four other top performing managedcare organisations in the United States. We found systematichighly proactive and personalised care—nothing in theorythat could not be provided in the NHS, although it frequentlyis not. Our conclusion was that . . . [Full text of this article]

Jennifer Dixon, director

¹ Nuffield Trust, London W1G 7LP

jennifer.dixon@nuffieldtrust.org.uk