Editor's blog Tuesday 13 July 2009: Darzi's departure - a Judas GOAT of clinical engagement?

So it has been confirmed that the good Lord Darzi is off up the road. Normally, ministers get 'kicked upstairs' to the Lords, but that was not really an option in Professor the Lord Ara Warkes Darzi of Denham's case.

The story was accurately called this afternoon by Sally Gainsbury of Health Service Journal.

Enrolled in newly-appointed PM Gordon Brown's government of all the talents (GOAT) in the summer of 2007 following his NHS London review, Darzi is reported to be tired by the demands of balancing of the demanding ministerial job with the desire to continue his clinical practice in robot-assisted surgery.

How big a deal is this departure? He attracted some genuine buy-in as a still-practicing clinician at the cutting-edge of innovation who could credibly have conversations about clinical quality. Perhaps surprisingly, Darzi formed a close working relationship with NHS CE David Nicholson. Darzi's departure will rob Nicholson of not only a clinical engagement figleaf, but a genuine ally.

I interviewed him only once, and found (even at the end of a long day for him) a strong and comabtive performer with an acutely political skill to answer only the bits of the questions suiting his agenda of the day.

His next-stage review, the statistically-improbably-named >'High-quality care for all' remains a commendably ambitious document. For all the recent brouhaha around its one-year anniversary, it is way, way premature to consider it to have made a significant impact. The NHS has not yet shown a willingness to follow his maxim to "localise where possible; specialise where necessary".

Perhaps sometimes, symbolism is enough.

Lord Darzi will return to clinical practice a sharper political operator. He wil get much of his life back (as his clinical practice was being fitted in at weekends).

So the goat is untethered. Critics, including Professor Alan Maynard of this parish, contended that Darzi's definition of quality was severely deficient. The late Bob Sang, reflecting on Darzi's impact, quoted Russell Ackoff's line that "quality is a term so general and ambiguous as to be almost completely meaningless. Use it as often as you can!"

Clinical engagement in the necessary management decisions of rationing and resource use has been the NHS achilles heel for a long time. In his 'one year on' proposal for giving clinical teams in acute trusts budgets, Lord Darzi might have come as close as any to an idea that could gain some "traction", in the trendy policy word.

The Judas goat is one of the breed chosen to smoke out the others for the hunters. Will Darzi's legacy be as one of these; or as a man who broke an impasse?

Time will tell. Legacy is one difficult six-letter word.