Darzi review stresses choice and information

Greater choice, better information and a legal duty for strategic health authorities to promote innovation are key themes of the government’s NHS next stage review launched today.

The report, which follows a 12-month review, led by health minister, Professor Lord Ara Darzi, is aimed at ‘giving patients more say and staff more freedom to shape high quality care round patients’ needs.’ The next stage review is intended to provide a blueprint for the NHS for the next ten years.

A draft NHS constitution and a workforce strategy were also published today, but the Swindells informatics review, which was originally due at the same time as the next stage review, has now been held back for later this summer.  No reasons for the delay were given.

The next stage review sets no new top-down targets. Instead every provider of NHS services will need to systematically measure, analyse and improve quality, displaying it to staff through ‘clinical dashboards’ to measure their performance and use the information to make continuous improvements.

The final report says that patients must be empowered with greater choice, better information and more control and influence. As a result, the government has made the right to choose where a patient seeks treatment, and which GP they register with a legal right.

“We believe that choice should become a defining feature of the service. A health service without freedom of choice is not personalised… providing greater choice of GP will mean developing fairer rewards for practices that provide responsive services and attract more patients,” the report says.

This will be encouraged through the use of better information, which will include measuring the quality of care and outcomes of treatment across the service and publishing it online using the NHS Choices website.

“We want patients to make the right choices for themselves and their families. So we will empower them to make informed choices. NHS Choices will publish clear information on the quality of care each service offered by every NHS organisation – across all settings of care,” Lord Darzi said at a news conference this afternoon.

A pledge on information will also be in the forthcoming NHS Constitution, the draft of which was also launched today.

The constitution pledges to patients that ‘comparable information on every aspect of high quality care, including safety and cleanliness, patient satisfaction and outcomes, will be freely and openly available online, and will be reliable.’

Healthcare providers will be obliged to publish these ‘Quality Accounts’ from April 2010.

The draft constitution, which will not be legally binding, also pledges patients can access their health records at any time, and they will only be used to manage their treatment in their best interests.

It reminds staff that they have a duty to protect the confidentiality of personal information they access, but falls short of setting any punishments should this be breached.

Information will also be displayed through the use of digital dashboards. These are currently being piloted in three sites and present information to patients on waiting times and patient satisfaction amongst other issues.

In primary care, the Quality and Outcomes Framework will see a new strategy being introduced. “An independent and transparent process for developing and reviewing indicators,” is promised.

The review also encourages further use of innovation, including telemedicine, to help ensure quality of care is as high as possible.

A Commissioning for Quality and Innovation scheme will be introduced as “an overlay to the Payment by Results system…” says the report. It says NHS providers will be rewarded in the first year for submitting data.

Innovation will now be a legal duty for SHA’s to promote, and they will be given regional innovation funds to spend on identifying, growing and diffusing innovation.

Integrated care organisations will be piloted “bringing together health and social care professionals from a range of organisations – community services, hospitals, local authorities and others, depending on local needs.” An invite for proposals is to be issued shortly.

A new set of web-based tools to support allied health professionals with their continued professional development will also be launched this summer.

The review only briefly mentions the 150 new GP- led health centres which are intended to offer convenient GP access and other services including diagnostic, mental health and sexual health services. The national report, says local needs and priorities differ, so there is no national blueprint and SHA’s should decide these individually.

Darzi said: “By setting clear standards, and recognising and rewarding innovation in quality, we can keep pace with the very latest advances in medicine and technology. By investing in additional health centres and services for GPs the NHS will diagnose illness faster.”

Health secretary, Alan Johnson, added: “These locally driven, clinically led plans show how quality of care will be raised right across the country, with doctors and nurses supported to offer big improvements.”