by Irene Zoupaniotis
HOW patients perceive and rate the quality of their care while being treated by the National Health Service will, in future, affect the funding of hospitals and general practitioners in England. Information on “service quality” will also be displayed on new “dashboards” in hospitals, GP surgeries and on the worldwide web.
It is also proposed to change the way GP practices are funded to make it easier for patients to switch from one practice to another.
These announcements are at the heart of the Darzi review in which the junior health minister – and leading surgeon – sets out his plans for the NHS in England over the next 10 years.
Ara Darzi launched his report in London on Monday (June 30) on the eve of celebrations to mark the 60th anniversary of the founding of the NHS. The Next Stage Review follows a 12-month process of “looking, listening and learning” involving consultations with 60,000 patients and staff.
He said: “This is about giving more clout to patients and more say to patients. By measuring quality across the service and publishing that information for the first time, staff and patients can work together to make better informed choices about their care.”
Health Secretary Alan Johnson said: “We must have an unwavering, unrelenting focus on quality.”
Mr Johnson and Lord Darzi emphasized their aim of bringing “clarity to quality” and streamlining what they described as a “morass” of existing standards.
The devil, as always, is in the detail and just how patients’ assessment of the quality of their care is to be measured has still to be decided. But it will have a major impact on how much money an NHS organisation receives. Quality-linked funding is likely to make up about £10 million of the average district general hospital’s budget of £250 million.
Lord Darzi said all the quantitative investments, such as an increase of funds, doctors and nurses and the removal of waiting lists, have now been made. “We can now aspire to qualitative improvements for quicker and better care.”
Every NHS provider at every level will have to publish “quality accounts”.
Lord Darzi said: “As a surgeon I know how vital it is to balance the quality of the patient’s experience – a clean and safe environment, being treated with compassion, dignity and respect – with
the success of the treatment they receive.”
A draft constitution would, he said, enshrine the fundamental principles of the NHS and set out the rights and responsibilities of patients, staff and providers.
All patients with long-term conditions will be given personal care plans and 5,000 will pilot a “personal care budget”.
Patients will be able to get any appropriate drugs approved by the National Institute for Health and Clinical Excellence – and the NICE appraisal of new drugs and treatments will be speeded up so they take six months rather than two years.
Patients will be able to choose a practice – and a particular doctor – and also be able to seek treatment elsewhere in Europe if faced with “undue delay” in England.
In an earlier report, Darzi proposed the creation of 150 new health centres to be open for 12 hours a day – from 8am to 8pm – seven days a week.
This has been opposed by doctors’ leaders who fear it will harm existing primary care provision.
In this report he goes further in changing how GPs work and proposes removing the minimum income guarantee which, he said, acts as a disincentive for practices to take on new patients.
He advocates a new system of payments linked to improved access and quality of care. GPs will be able to commission care themselves and there will be more emphasis on preventing people getting ill by giving them more help to improve their diet or stop smoking.
Mr Johnson told the House of Commons: “Society cannot stand still in the face of scientific and social change and neither can the NHS. On most objective measures, the NHS is performing better than ever. Restoring the NHS was one of our top priorities in government and, following almost two decades of neglect, a huge amount of reform in a short period of time was unavoidable.
“Now we need to make sure that the NHS keeps up with the changing demands and expectations of patients. New drugs, medical technologies and better clinical practices provide huge opportunities while lifestyle diseases and an ageing population present major challenges.”
