Analysis: Lord Darzi's NHS review

Lord Darzi's review summary
Lord Darzi's review summary

Lord Darzi's review of the NHS appears to offer users and providers a lot. What is less clear is the government's desire to get something back in return.

Innovation, quality and patients' rights are the cornerstones of the Next Stage review.

Its proposals come days before the organisation celebrates its 60th anniversary on Friday and will see major changes to the organisation.

Both healthcare professionals and the general public will have increased pressure on them to raise their game.


Lord Darzi steers well clear of the top-down approach which the Labour government has previously imposed on health professionals. But he plans to raise standards of quality and plans on enforcing them thoroughly.

There are raised expectations on members of the public to improve their own health, although Lord Darzi is equally clear about his desire not to antagonise users of the service. He directly denies the government plans to strengthen the "nanny state".

The deal for patients

The review focuses heavily on raising standards of healthcare by helping people stay healthy, however.

Primary care trusts will get comprehensive wellbeing and prevention services. Obesity will be the first target for renewed partnerships between the government, private sector and voluntary organisations. Awareness of vascular risk assessment will be improved. And Fit for Work services will be introduced, improving health in the workplace.

In return for all this, the government seems determined to drive through changes which will strengthen patients' rights.

Choice of GP practices will be extended. A new right to choose will be included in the NHS constitution. A personalised care plan will be guaranteed for all those with long-term conditions. And personal health budgets will be piloted, while individuals and families will get greater control over their own care.

For patients, therefore, the bargain is a simple one. Keep more healthy - and get more out of the NHS when you can't help getting ill.

The deal for providers

Healthcare professionals, too, are expected to improve in return for more.

Lord Darzi makes clear the government will step up its efforts to drive up quality throughout the NHS.

The Care Quality Commission will be handed new enforcement powers. The National Institute for Clinical Excellence will be expanded to set and approve more independent quality standards. Quality levels will be published from the ground up, while hospitals which receive negative responses from patients will see their funding cut as a direct result. And NHS organisations will have to improve to keep up under new best practice tariffs.

Despite all this, Lord Darzi insists there will be no new national targets introduced as a result of his review.

In fact the government hopes it will get more out of its NHS employees by giving them greater independence.

Clinicians will be more involved in the running of primary care trusts, which will be required to provide strategic plans. New funds and prizes will be set up to support and reward innovation. NHS staff will have a greater role in leading and managing the organisations in which they work. And there will be a "clear focus on improving the quality of NHS education and training" to help them achieve this. Investment in apprenticeships will be doubled.

A new constitution

Nowhere is this quid pro quo less apparent than in the NHS, which puts the rights of patients centre stage.

"An NHS constitution will help patients by setting out, for the first time, the extensive set of legal rights they already have in relation to the NHS," Lord Darzi concludes.

"It will ensure that decision-making is local where possible and more accountable than it is today, providing clarity and transparency about who takes what decisions on our behalf."

Such measures are all welcome. They will certainly be easy to sell for a governing party keen to reinvigorate its traditional lead on the institution it brought into being 60 years ago. The Next Step review gives Gordon Brown's Labour the opportunity to do this. Just don't overlook the small print, which shows the proposals are less one-sided than first appears.

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