Health minister Professor Lord Ara Darzi published the report of his wide-ranging review of the NHS in June 2008. High Quality Care For All set "a new foundation for a health service that empowers staff and gives patients choice. It ensures that healthcare will be personalised and fair, include the most effective treatments within a safe system, and help patients to stay healthy".
One year on, Darzi has published a progress report, High Quality Care for All: Our Journey So Far, which highlights achievements so far and outlines plans to drive up the quality agenda even further and free up clinicians' time to do this. The key points and new initiatives mentioned in the document include:
- Darzi is keen to ‘embed the principles of service line management across the NHS.’ This idea, along the lines of practice-based commissioning, is aimed at empowering clinicians in the acute sector by providing them with their own budgets. The report notes that Monitor has already endorsed the approach within FTs. Dr Mark Goodman, chief executive of Heart of England FT and clinical leadership representative on the Leadership Council, will be working with Sir Bruce Keogh on this.
- The 13 week outpatient and 26 week inpatient performance targets will be abolished, in advance of a review of other targets and data collection commitments. The findings of the review will be incorporated into the 2010/11 Operating Framework.
- A ‘new common approach to accreditation’ will be developed in an attempt to consistently recognise excellence across the NHS. The Government will work with the Royal Colleges on this, with the National Quality Board also having a role to play.
- The Boorman review into the health and well-being of NHS staff is highlighted, with Darzi stating that it will report in the autumn to enable the recommendations to inform the 2010/11 Operating Framework.
- A Centre for Workforce Intelligence will be in place from December and work alongside NICE to evaluate the workforce implications of ‘the impact of new developments and standards in clinical care.’
The document can be downloaded from the Department of Health website.
Implementation
Since the report's publication our priority has been to ensure implementation of the review delivers real and sustainable benefits for patients, the public and NHS staff. We particularly welcome:
- the focus on defining quality, measurement and incentives to support this
- the absence of major restructuring
- a permissive and experimental approach to more controversial areas
- the broad consistency with existing policy
- the emphasis on prevention as well as treatment services.
Our Taking forward the NHS Next Stage Review working paper gave our overall view of the review, along with an analysis of the key issues arising from it and our views on the priorities for action. The paper is informed by discussion with NHS Confederation members at our Council meeting in July 2008 and we are continuing to collate views from networks and members. Email nigel.edwards@nhsconfed.org with your views.
Vision for primary and community care
On 3 July 2008 the Department of Health published its vision for primary and community care as part of the NHS Next Stage Review, setting out the future direction for primary and community care in England. NHS Confederation chairman, Bryan Stoten, said: "This strategy presents opportunities for partners across primary care to work together to improve patient care and this is something that clinicians will be keen to engage with. We know people increasingly want a greater say in their health services and control of their own care."
Informatics review
The Department of Health published the report of its health informatics review on 10 July 2008, part of the NHS Next Stage Review. The health informatics review set out to:
- assess the supply of, and demand for, information across the NHS and social care
- make sure that, five years after the commissioning of the National Programme for IT (NPfIT), the framework for the NHS Care Records Service and the Secondary Uses Services (SUS) is in line with recent, current and potential future policy
- to ensure that the governance of informatics within the NHS and the Department of Health (DH) is clear and appropriate.
Our 2008 Health Informatics Review briefing for members sets out the key points.
The NHS Constitution
Overall, we support the Government's plans for an NHS Constitution but have raised some questions about:
- how it will apply to different patients and providers
- how sustainable it is
- the process for implementing it.
We will continue to work with the Department of Health as the Constitution develops, including responding to its three questions to NHS organisations about implementation.
Influencing the NHS Next Stage Review
The NHS Confederation worked hard to influence the review, working closely with the review team to feed through views and facilitate discussion with members. We submitted detailed comments in August 2007 and January 2008, and senior NHS Confederation representatives took part in the review's national working groups.
Our Challenges for Darzi report in May 2008 highl ighted the ideas we believed could make the biggest difference. And, to assess whether new policy is likely to produce good outcomes for patients and the public, the report includes a set of tests as a framework for assessing and developing it.
Review reading
- Taking forward the NHS Next Stage Review (August 2008) sets out our overall view of the review, along with an analysis of the key issues arising from it and our views on the priorities for action.
- Read our July 2008 briefing for members which summarises Professor Lord Darzi's report and sets out the Confederation viewpoint.
- The NHS Constitution briefing for members (July 2008) outlines the key points of the Government's consultation.
- Our May 2008 Challenges for Darzi report highlights some of the ideas we believe could make the biggest difference in making the review outcomes successful. But it warns that Lord Darzi must learn the lessons of previous poor policy making to ensure that NHS reform delivers real and sustainable benefits for patients and NHS staff.
- Local reports from the review are expected in summer 2008, but Professor Lord Darzi's May 2008 Leading local change report pledged that changes will be transparent and driven by the best evidence. Commenting on its publication, NHS Confederation policy director, Nigel Edwards, said: "We need to recognise that the substantial challenges around service change on the ground will not be overcome by clear guidance alone."
- In April 2008 we published Ideas from Darzi: polyclinics, a look at polyclinics, the key design rules for them and three possible models. This report also outlines key lessons learned, and the misconceptions and concerns associated with them.
- We produced a summary for members of Lord Darzi's October 2007 interim review report.
- Our paper Key issues for the Next Stage Review picked out a number of areas where NHS organisations believe that a change in policy or approach would have a significant impact on the success of the overall reform programme.
- Healthcare for London: a framework for action briefing looks at the key findings and recommendations from Professor Lord Darzi's 2007 review of healthcare in London, his vision for the future and the national implications.