Darzi Review

The review was based on reports from strategic health authorities and clinical pathway working groups that presented a vision for change in their particular localities. It was not intended to be a ‘national blueprint’ but a means of enabling these local visions to become a reality.

One of the chief drivers of improvement proposed was a range of local quality indicators – measuring mortality, complication and survival rates as well as patient perceptions – to enable clinicians to benchmark and improve their performance. A small proportion of trusts’ income were to become conditional on quality indicators and trusts were now obliged to produce annual ‘quality accounts’ similar to their financial accounts. The first set of quality accounts was published in July 2010.

It proposed a formal constitution for the NHS, which came into effect in March 2010 and spelled out the underlying principles and values of the NHS as well as the rights and responsibilities of patients, the public and staff.  Patient rights include the right to any drug or treatment recommended by NICE (National Institute for Health and Clinical Excellence) as well as the right to choose one’s GP.

Darzi also identified a range of hospital services that could be delivered closer to the patient’s home, including minor surgery and many outpatient consultations, although some services such as stroke and heart disease should be more specialist and centralised. He confirmed his recommendation for 150 ‘GP-led health centres’ to supplement existing services but insisted that the precise range of services provided by these centres would be for local decision and that they would not ‘inhibit any patient’s continuity of care’.

PCTs together with local authorities were to be responsible for commissioning comprehensive well-being and prevention services, targeting six key goals: tackling obesity, reducing alcohol harm, treating drug addiction, reducing smoking rates, improving sexual health and improving mental health.

Patients with complex long-term conditions were to be entitled to a named care co-ordinator, such as a community matron, to help them access the services in their personal care plans. Personal budgets for health care, similar to those available in social care, were piloted among 5,000 patients with chronic conditions in 2009.

The Darzi report was generally well received. But cultural change, which is at the heart of these reforms, is usually a lengthy process and one that can be difficult to measure. The new powers given to clinicians could conflict with the commitments on patient choice and control. And the very different ‘visions’ put forward by SHAs could lead to significant variations in care and further accusations of a ‘postcode lottery’.