Page last updated at 17:37 GMT, Monday, 30 June 2008 18:37 UK

Cash-for-quality in new-look NHS

By Caroline Parkinson
BBC News health reporter

This is no ordinary health service. This is a top-quality health service.

surgeons
Quality of care will be paramount, the report says

Or at least that's what the government hopes people will think after its latest review of the NHS.

Lord Darzi's plan for the next 10 years of the health service in England does not set doctors and nurses new targets, nor does it call for wholesale reorganisation of the way services are delivered - as previous reviews have done.

What it does do is emphasise the importance of striving for high quality care, wherever and however a patient is using the NHS.

And patients will hold the purse-strings to a significant degree.

The proposals should be given a fair wind
Sir Ian Kennedy, Healthcare Commission

Hospital and GP practice funding will, for the first time, be partially linked to how good patients think their care has been - with their whole experience being measured.

These views will be made public on the web and on clinical "dashboards" in hospitals and surgeries, so patients will be able to make informed choices about where they go for their care.

Ministers believe that making the link between quality and funding, and offering patients greater choice will lead to improvements, as providers seek to avoid missing out on patients and therefore money.

As Lord Darzi said when he launched his review, the aim is to give patients "more clout".

Once in a generation?

A draft NHS Constitution published alongside the review sets out the rights of patients, such as greater choice of GP and the right to drugs approved by the NHS watchdog - as well as responsibilities such as taking part in vaccination schemes and abiding by treatment plans given by their doctors.

The response to the plans has been overwhelmingly positive, with commentators praising the amount of consultation with front-line NHS staff and patients.

Sir Ian Kennedy, chair of the Healthcare Commission said: "The proposals should be given a fair wind - they deserve one."

The King's Fund, the independent think-tank, said the review was "good news" for patients because it did not go against the grain of the way the health service was already operating.

But it warned it would be hard for it to live up to its "once in a generation" billing.

The big test will be to make it a reality
Niall Dickson, King's Fund

Chief executive Niall Dickson called the report a "sensible set of measures".

But he said: "The big test will be to make it a reality."

The King's Fund warns there are no estimates about how much the proposals in the review will cost, or how different the quality of services will be in five or 10 years time.

And Sir Ian Kennedy warned the Darzi review was short on detail about how performance against quality standards would be independently assessed.

'Let go'

The drafting of an NHS Constitution was welcomed, with Niall Dickson saying it would help people take greater contol of their healthcare through having more information and the Patients Association's Sally Brearley said it could be a "valuable and powerful document in the hands of patients to help them get the best quality care".

But there has been critism that the review does not go far enough in offering clinicians over how care is provided locally.

Doctors say the government still has not been able to "let go" enough.

The British Medical Association's Mark Porter said it was still not allowing clinicians and hospitals to focus on local priorities, and was still imposing "top-down targets".

Opposition parties also said the review still failed to recognise the need for Whitehall to "stop interfering" and end its micromanagement of the service, while the Liberal Democrats said that when the dust had settled, people would realise "the system of command and control diktat by Whitehall" lived on.


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