QUALITY, QUALITY, QUALITY

The NHS is undergoing a 10 year modernisation plan, which is expected to cost billions of pounds. Government has pledged that spending on health will rise and be similar to many other countries in the European union. How to measure quality and assess whether this investment is returning dividends is difficult to do—certainly care should be more convenient. The time waiting for procedures, admission to hospital, and in accident and emergency (A&E) departments should decline. Care should be more consistent with guidelines and presumably of higher quality. As described by the Institute of Medicine in the US, a 21st century health care system should be safe, effective, patient centred, timely, efficient, and equitable (1). In this issue, Armon and colleagues describe the impact of integrated care pathways (ICPs) on the management of diarrhoea and seizure in a single paediatric A&E department. ICPs are more prescriptive and comprehensive than clinical guidelines, detailing essential steps of care (nursing, medical, laboratory) in patients with particular problems (a specific diagnosis or set …