Lord Darzi's
NHS Next Stage Review sets out the government’s plans for NHS reform in England over the next 10 years. Its principal focus is on driving up the standards of quality in health care and putting clinicians at the heart of change. It is also intended to be locally driven.
The review is based on the reports from strategic health authorities and clinical pathway working groups that presented a vision for change in their particular localities. It is not a ‘national blueprint’ but a means of enabling these local visions to become a reality.
One of the chief drivers of improvement will be a range of local quality indicators – measuring mortality, complication and survival rates as well as patient perceptions – that will enable clinicians to benchmark and improve their performance. A small proportion of trusts’ income will also become conditional on quality indicators. Trusts will be obliged to produce annual ‘quality accounts’ similar to their financial accounts. Quality Observatories will also be set up in each region, and a National Quality Board (NQB), chaired by the NHS chief executive, will report to ministers on progress. The GPs
Quality and Outcomes Framework will be modified to take account of these quality requirements. Membership of the NQB has been finalised and it has now begin its work. Meanwhile the quality framework designed to help local clinical teams improve their quality of care is available for use.
For the first time the NHS will have a formal constitution, spelling out its underlying principles and values 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. The constitution has now been published following consultation and, subject to its passing in the current Health Bill, will impose legal duties on all providers and commissioners. It will be reviewed every 10 years.
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 will now be responsible for commissioning comprehensive well-being and prevention services. They will target six key goals: tackling obesity, reducing alcohol harm, treating drug addiction, reducing smoking rates, improving sexual health and improving mental health. By spring 2009 all PCTs had to publish plans setting out their five-year strategies for improving the health of people locally.
Patients with complex long-term conditions will 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’.
