Darzi review must set out clear vision for future of NHS based on less control and more freedom for staff

A call for a clear statement about the way forward for the reformed NHS was put forward today, in our new report: Making it Happen: Next steps in NHS reform

An expert working group made up of leaders from the NHS and independent sector called for Lord Darzi’s review of the health service to ensure that at the next stage in NHS reform health professionals and managers are given much greater freedom. They must be allowed to innovate and develop services that are responsive, cost effective and continuously improving the quality of care.

The working group’s vision was that:

  • Ministers and the Department of Health focus on setting standards, goals and priorities for the NHS and to hold local organisations to account for what they deliver. Day-to-day operational matters, and decisions about precisely how those goals are achieved, become a matter for the local health service
  • the NHS increasingly becomes a commissioning rather than a providing organisation – a range of freestanding, and regulated, organisations would be responsible for their own success and failure, whether they are NHS foundation trusts, GP practices, social enterprises, independent or voluntary providers
  • patients be given significantly more choice over how and where they receive care, underpinned by easier availability of information about the quality of care provided by organisations.

Commissioned by The King’s Fund and charged with producing recommendations to inform Lord Darzi’s review, the group examined the raft of reforms that have been introduced to the NHS in recent years, including patient choice, Payment by Results, foundation trusts, practice-based commissioning (PBC) and greater use of the private sector.

They argue that the main driving force for improvements in health care quality and efficiency would come from commissioners’ informed purchasing decisions, while patient choice would provide an additional incentive but should not be seen as the sole lever for improved quality.

Working group chair Alasdair Liddell said:

'Reform of the NHS in England has reached a critical point. Lord Darzi’s imminent review provides an ideal opportunity for the government to set out clearly its own vision of a decentralised and responsive health service, where day-to-day ministerial involvement in its operation becomes redundant and the need for centralised performance management is much reduced. Without this much-needed clarity from ministers, the NHS will continue to be directed from the centre in a way that risks stifling professionals and local services.'

He added: 'Many of the new reforms have been in place for a very short time so it would be wrong to dig everything up by the roots to examine its progress before much of it has had the chance to flower. We see our report as offering an opportunity to ensure the new system delivers quality and value for patients and the public.'

The report outlines a series of recommendations for making the health care system work. These include:

  •  More competition in primary care – general practice and other primary care services should be opened up through greater use of competition and contracting mechanisms, so that these services are eventually commissioned on the same basis as other services. The minimum income guarantee for GPs should be phased out.
  • The future of PCTs as commissioners – ministers should set a clear timetable for PCTs to stop providing services themselves and instead to focus on the real task in hand – commissioning. The Department of Health should work with strategic health authorities to develop a range of organisational models and a detailed human resources plan to protect the interests of staff affected by PCTs separating from their provider arms.
  • Practice-based commissioning – ministers should consider PBC as just one element in a suite of commissioning tools that may be used locally. But where GPs want to provide a wider range of services, practices (or groups of GP practices) should be commissioned as principal contractors – rather than as commissioners in their own right.

The King’s Fund Chief Executive Niall Dickson added:

'The government’s reforms of the NHS in England have gone from central directives, targets and performance management in the early days to developing a range of market-based reforms intended to drive up the quality of care. We are still at an early stage in this journey and further progress is needed if patients are to benefit fully. To give these reforms the best chance of succeeding, the government’s vision for the NHS over the next decade needs to include handing greater control and freedom to professionals and local health services.'

Read the report: Making it Happen: Next steps in NHS reform

Notes to editors: 

  1. For further information, embargoed copies of the report or interviews, please contact The King’s Fund press and public affairs office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.
  3. Making it Happen: Next steps in NHS reform is free to download. This paper is the report of an expert working group established by The King’s Fund to examine the systems and incentives involved in the current NHS reforms in England, and their state of play, as a contribution to Lord Darzi’s NHS Next Stage Review. The members of the group were as follows:
  • Alasdair Liddell, Senior Associate, The King’s Fund (Chair)
  • John Appleby, Chief Economist, The King’s Fund
  • Penny Dash, independent consultant and Trustee, The King's Fund
  • Anna Dixon, Acting Director of Policy, The King’s Fund
  • Mike Farrar , Chief Executive, NHS North West
  • David Mobbs, Chief Executive, Nuffield Hospitals
  • Keith Palmer, Chair, Barts and The London NHS Trust
  • Stephen Thornton, Chief Executive, The Health Foundation
  • Nick Timmins, Public Policy Editor, the Financial Times (Rapporteur)