Page last updated at 15:12 GMT, Monday, 30 June 2008 16:12 UK

Viewpoints: Darzi review of NHS

Health minister Lord Darzi has announced plans for significant changes to the way the NHS in England will work in the future.

They include moves to focus on the quality - rather than quantity - of clinical care, and to set up new GP super-surgeries.

Leading figures in the health world give their reaction. Click on the links below to read what they have to say.

Dr Hamish Meldrum, British Medical Association

Dr Richard Horton, The Lancet

Sir Ian Kennedy, Healthcare Commission

Dr Peter Carter, Royal College of Nursing

Niall Dickson, King's Fund

Neil Hunt, Alzheimer's Society

Ian Beaumont, Bowel Cancer UK

Jon Skewes, Royal College of Midwives

Dr Hamish Meldrum, Chairman, British Medical Association

"There is much here that could bring about improvement - if it can be delivered.

That will depend on the details, and on the true engagement of NHS staff in implementing change.

We are pleased the government has stated its intention to move away from target-driven health policies and to focus instead on the quality of patient care.
Dr Hamish Meldrum
British Medical Association

"If they are sidelined, these are little more than fine words and we won┐t see the improvements the NHS desperately needs.

"In some areas there was insufficient consultation with the public or staff on changes to local NHS services during the review process and we don't want to see that repeated in the future.

"An NHS constitution is something that the BMA has called for and the public deserves a clearer idea of what it can expect from the health service it funds.

"The constitution should also empower staff, working with patients, to run the health service locally without the day to day interference of politicians.

"We are pleased the government has stated its intention to move away from target-driven health policies and to focus instead on the quality of patient care."

Dr Richard Horton, Editor, The Lancet

"Darzi has wisely thrown out regulation as the organising principle of the NHS.

"He has replaced it with quality, by which he means clinical effectiveness, patient safety, and the patient experience.

His achievement should not be underestimated
Dr Richard Horton
The Lancet

"This cultural shift is a radical re-visioning of purpose for the NHS - away from the political command and control of processes and towards professional responsibility for clinical outcomes.

"His achievement should not be underestimated.

"He has managed to engineer a major shift in government policy, language, and tone.

"He has revised the role of the Department of Health to one of setting values, principals, standards, and rights.

"He has also revived the part professionals can play in leading NHS quality improvements."

"Proper attention will be paid to the people who make the NHS what it is -its staff.

"Instead of being criticised, blamed, and threatened, NHS professionals will be consulted more, receive better training (with funding following the trainee), undergo leadership development in the undergraduate and postgraduate years, and have more attention given to their health and wellbeing."

Sir Ian Kennedy, Chair, Healthcare Commission

"This has a real chance of helping to improve the quality of care that patients receive.

"The proposals should be given a fair wind - they deserve one.

"While we welcome the objectives of this review, it is essential to have an independent assessment of progress.

"The document is somewhat short on how this will come about and the role of regulation. We will be raising this with the government.

"We have been working for the past three years to embed, for the first time, core standards on the care of patients right across the NHS.

"We therefore welcome a Constitution that will help keep the spotlight firmly on standards and the quality of care."

Dr Peter Carter, General Secretary, Royal College of Nursing

"The RCN welcomes the recognition by Lord Darzi's Review that future healthcare provision should aim for a more quality based approach, and that nurses can play a lead role in its shaping and delivery.

"The overwhelming majority of care provided by the NHS is safe, but the RCN believes the ambition now must be to drive up patients' experience from a 'safe' to a 'high quality' service.

"If fully implemented, these recommendations have the potential to achieve this ambition.

"We also welcome the Review's recommendation to increase investment in nurse education and training.

"And, that in the future the NHS will have a culture where nurse leaders are supported and empowered to effect meaningful change."

Niall Dickson, Chief Executive, King's Fund

"The good news is that there is no top-down re-organisation or any dramatic changes in direction.

"Instead the report is a sensible set of measures to improve quality and equity, and a clear signal that responsibility for shaping and leading health services lies with staff at local level.

"This will be a new era in which patients will be able to check on the quality of the services they are being offered from infection levels to success rates following operations.

"All this should help us all make more informed choices and put pressure on those providing the care to do better.

"To make this happen we need a decentralised health service, with less central control, leaving local organisations responsible for how they deliver care but accountable for its quality.

"While services provided by the NHS are far from uniform, increasingly devolved decision-making could result in significant regional variations in the care provided to patients.

"So far there are two significant omissions - there are no estimates of how much all this will cost and no indication of just how different the government expects the quality of health services to be in five or ten years time."

Neil Hunt, Chief Executive, Alzheimer's Society

Lord Darzi's ambitious vision could have enormous benefits for people with dementia.

"Creating 'polyclinics' could potentially give people greater access to memory services and the specialist support they require, perhaps removing the need for hospital visits and ensuring that people get access to an earlier and accurate diagnosis.

"Speeding up evaluations of NHS treatments and giving people the universal right to approved treatments can only be positive.

"Changes must also ensure that that the wider benefits of treatments to society, particularly carers, are considered.

"England's record on dementia care is damningly poor. Currently only a third of people ever receive a formal diagnosis and if they do they are then shunted between a health and social care system that fails to meet their needs.

"The NHS must wake up to its responsibility to care for this incredibly vulnerable group of our society."

Ian Beaumont, Bowel Cancer UK

"While we welcome the fact that more patients will be able to access NICE approved drugs, we remain concerned that NICE appraising new treatments earlier will not result in more new drugs being made available to patients.

"NICE will still be judging treatments on grounds of cost not efficacy; by appraising treatments earlier, NICE is likely to claim that the evidence for them isn't robust enough; and if the proposed co-payments system is introduced, there will be no incentive for NICE to approve new treatments anyway.

"If the government is genuinely committed to increasing access to new treatments, then NICE needs to move away from its outdated and simplistic QALY (Quality adjusted life years) system and tailor its appraisal process to match the criteria used in drug trials."

Jon Skewes, Royal College of Midwives

"For too long the NHS has been about throughput and quantity and not about the level of care that people actually get.

"There is no doubt that this document sets out to redress that balance, and the focus on quality of care and outcomes is welcome.

"However, the review is quality and choice-heavy, but the reality in maternity services is too often choice-light, with quality at the mercy of midwife shortages and under-funding.

"If we want to see real quality and choice in maternity services, then we need to see real action. Investment needs to follow the grand strategy outlined today, and the government need to come good on their promise of more midwives."

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