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Darzi proposals must be locally led to be effective, say commentators

1 July 2008

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Healthcare leaders and commentators have responded to Lord Darzi’s final report of the Next Stage Review, launched yesterday (30 June 2008). While generally welcomed in principle, questions have been raised over some of the report’s finer details.

The NHS Confederation have said the proposals put forward “will enable a major improvement in quality of care and patient experience” – so long as change is enabled at a local level.

Steve Barnett (pictured), acting chief executive of the NHS Confederation, said: “The review contains most of the ideas NHS leaders told us they wanted.

“In particular, we think the combination of three powerful ideas running through the report could make a major difference: patients being aware of their rights, choices and information; industrial scale feedback and measurement of quality and patient experience; and, capitalising on the motivation of NHS professionals to provide the best possible care with peer review and competitiveness.

“Together this should provide an additional powerful motor for change in the NHS,” he added.

However, Mr Barnett warned that, to be successful, implementation must be led locally. “The proposals appear to be highly permissive and could mark a shift in the NHS towards local control if embedded,” he said.

“The Department of Health will need to resist the temptation to prescribe nationally and local staff will need to avoid looking upwards for direction. Local delivery requires local leadership and local really must mean local.”

These comments echoed those of the NHS Alliance Chairman Dr Michael Dixon, who said: “We need to take care that SHAs do not become the new centralists, imposing their own top-down decisions.
Local must mean what it says – local professionals and patients working together and making decisions about the services their communities need.”

The NHS Confederation also welcomed the emphasis on local leadership in the Darzi review, but cautioned that this needs to be followed through consistently in the approach to leadership development.

Steve Barnett said: “We argued in the review for an emphasis on middle managers and clinical leaders, not just the top leaders, because the real difference will come from leaders at the frontline and the service itself.”

Melanie Lawless, Executive Director of Policy at the Improvement Foundation, an independent organisation working across the NHS to support service improvement, said: “The review mirrors our vision for high-quality healthcare with strong emphasis on primary and community services to delivery quality services that make a real difference to health and social care of NHS patients.”

Elsewhere though, policy thinktank Civitas admired the “grand vision” of the report, but argued that “the structure of the NHS works against” the changes proposed.

Civitas claimed that the proposals – including extending the rights of patients to choose their GP, piloting individual budgets for patients with long-term conditions and placing an emphasis on GP-led commissioning – “have real potential dramatically to improve responsiveness, outcomes and patient experience.

“Lord Darzi is entirely correct in focusing on quality, not quantity; a quality service is, after all, what matters to patients.”

Yet James Gubb, Director of the Health Unit at Civitas, said that, with the NHS, “the ‘customer’ has always been the government, not the patient, with massively perverse consequences”, arguing that centralised performance-driven targets have “militated against high-quality, personalised care”.

“On its 60th birthday, Lord Darzi’s report offers an enticing vision,” Mr Gubb said. “But it is clear that the government – be it through the DH or SHAs – will still be calling the shots.

“If there is one lesson from the past 10 years, it is that this is no way to run a health system. Service developments are best driven by user empowerment, not top-down pressure.”

NHS Confederation

Improvement Foundation


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