Many column inches and editorials have been focused on the main issues that others have highlighted and to some extent amplifying further the Darzi and Dash report findings.

Widespread reporting of the Darzi and Dash reports play into the headline grabbing narrative of a “broken NHS”. The reports capture concerns about how the NHS is being led and the resulting disparities and dissatisfaction in patient experience and outcomes, leading to a declining confidence of the public in the NHS. Trust board members are grappling with the considerable challenge of closing the financial gap, delivering positive patient experiences and maintaining the quality and safety of services.

With more change likely to come from arm’s length bodies including the NHS regulator CQC, Trusts may feel the pinch not only in terms of balancing the books but also ensuring a step change in quality improvement to deliver safe and high-quality patient care. King’s Fund chief executive Sarah Woolnough said: ‘[The] review makes clear that incremental improvement will not do – radical change is needed.’

We, at Aqua, recognise the scale of the challenge for those leading organisations we work with, but our experience is that the commitment, drive, creativity, collaboration and wisdom of those working in the NHS remain its largest asset. Aqua is an established NHS improvement and leadership consultancy which is not for profit and hosted by Northern Care Alliance in the Northwest. While the reports articulate the problems well, we have been working for more than a decade with NHS organisations that can evidence how empowering and equipping staff to improve by building cultures of continuous improvement and using data more effectively are vital parts of the solution. Our offer is to help providers avoid false alarms and false assurance and focus their improvement efforts effectively, using methods such as Advancing Quality (AQ) to focus on data quality, for example the level of mis-diagnosis and mis-coding in pneumonia is very high (around 1 in 3 overall). The AQ process filters out the mis-attributed cases. Using the lens of Quality Improvement enables organisations to simultaneously address making health and care safe, (clinically and cost) effective, patient-centred, timely, efficient, and equitable, and giving the people closest to problems affecting care quality the time, permission, skills and resources they need to solve them (adapted from The Health Foundation, 2021). Not to be forgotten is the need to pay attention to environmental sustainability in line with health outcomes not as an addition but threaded through all our improvement, SusQI, being an approach which embeds sustainability into current QI Practices.

Every day we work with health and social care teams to deliver improvement with impact through a systematic approach to diagnosing problems, selecting the best evidence-based approaches, establishing the culture and leadership skills required for change, and defining outcomes and measurement for sustainability. The Darzi review highlights that a major barrier to implementing this radical change is a shortage of people with the strong management and leadership skills and capabilities to create and nurture improvement cultures. This is often compromised when there are significant funding shortfalls with pressure to reduce headcount and limit investment in staff development. We see the NHS at its best where staff feel supported and enabled to make changes which in turn deliver improved experience.

The NHS is a world leader in the creation and use of data and is just starting to unlock the opportunities to widen this further by building on a performance led approach to create insight and learning from data on patient and staff experience, workforce, clinical systems and a wealth of other sources to identify opportunities to improve productivity, experience and outcomes. Impactful improvement includes diagnosing the issue, selecting the appropriate approach, establishing the culture and leadership skills required for change, defining outcomes and measurement for sustainability.

Whilst productivity has been challenged in terms of transparency on activity, spending and workforce, there is an expectation that improved data will empower leaders to act to drive improvement and outcomes across all health sectors.  Leaders need to pay attention to how they can transform the use of data in the NHS as a means of managing resources more effectively, improving the experience of those using and delivering services and ultimately improving the outcomes for patients.

Author

Dr. Susy Cook

Dr. Susy Cook, Aqua’s Chief Executive Officer is a dedicated and innovative Executive and Board member who brings a wealth of experience across 25 years in the NHS and academia in varying roles from Manager, Director, Coach, Leadership and Organisational Development Lead, and Improver.

Prior to joining Aqua in September 2024, Susy was the Group Chief People Officer at North Tees and Hartlepool NHS Foundation Trust and South Tees Hospitals NHS Foundation Trust and started her career as a biochemist and researcher in 1997.

With a deep commitment to healthcare excellence and a track record of effective leadership in the NHS, Susy will further develop a shared sense of purpose, motivation for improvement, and growth during an exciting time of change for the NHS.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.