Introduction
The NHS Next Stage Review, High Quality Care for All – to give it its full title – sets out the government's plans to reform the NHS in England over the next 10 years.
The review, led by the health minister and cancer surgeon, Lord Darzi, intends to shift the emphasis of the health service from increasing the quantity of care to improving its clinical quality. Hospitals and GPs will be given financial incentives to improve their quality of care. Meanwhile patients' rights and responsibilities are set out in a new NHS constitution. A workforce strategy is also intended to improve the skills and career progress of NHS staff.
Quality of care
The income of hospitals and GPs will in future depend on how much they improve their patients' health. NHS trusts will be paid according to the outcome of treatment, using a new set of indicators ranging from surgeons' death rates to surveys of how well patients feel after treatment. GP practices will be rewarded for improving access for patients. Patients' views about the quality of service and the compassion of staff will be regarded as just as important as the medical outcomes. From 2010, there will be financial bonuses for NHS organisations that provide high quality care. A new National Quality Board will be set up to advise the government and publish annual reports – starting next year - on the state of standards of care in England.
Better regulation
The remit of the new Care Quality Commission, which will regulate adult social care and hospitals, will be extended to cover GP and dental practices.
Greater competition
To establish a more thrusting marketplace within the NHS, patients will be given enough information to be able to choose the nearest GP practice and hospital that can demonstrate superior medical care. All NHS bodies will be required by law to publish "quality accounts", just as they publish financial accounts, which set out the quality of care they are providing.
Patients' rights
A new NHS constitution sets out what patients have a right to expect from the NHS. This includes rights to dignity, privacy, confidentiality and the opportunity to get a second opinion from another doctor. It also explains who is accountable if mistakes are made and how patients can make complaints. The document also lists patients' responsibilities. For example, they will be expected to keep GP and hospital appointments and take steps to improve their health. But patients' access to treatment will not be denied if they do not meet their responsibilities.
Patient choice
The constitution claims to enshrine a patient's right to choose where they want to be treated. But this will simply raise awareness of patients' treatment preferences with doctors rather than guaranteeing which hospital or surgeon an individual will see. Patients will have a right to register with the GP of their choice.
Ending postcode lotteries
The NHS constitution will also enshrine in law a universal right to approved treatments if they are clinically appropriate for individual patients. Primary care trusts, which run local NHS services, will no longer be able to deny patients potentially life-saving treatments just because they think it is unaffordable. This is intended to end the so-called "postcode lottery" of drug treatments, which has seen patients in some areas denied funding for drugs that are freely prescribed elsewhere.
Approving new drugs
The National Institute for Health and Clinical Excellence (Nice), which decides what drugs should be available on the NHS, will no longer wait until a drug has been licensed as safe before starting its assessments, which could reduce delays to a maximum of six months.
Preventing ill-health
Every health authority and council will jointly commission services to improve the wellbeing of the local population and prevent ill health. These will focus on tackling obesity, reducing the harmful effects of alcohol, treating drug addiction, cutting smoking, reducing sexually transmitted infection and improving mental health. There will be a national campaign to educate people about how to reduce their risk of suffering from heart disease. A new Fit for Work service will also help people with ill health return to work faster.
Personalised care
Fifteen million people with a long-term health condition, such as asthma or diabetes, will be given a personalised care plan. Under a pilot scheme, 5,000 individuals and families will also be given personal health budgets to give them greater control over the care they receive.
GP services
Darzi's interim report set out plans for polyclinics in London and super-surgeries throughout the rest of England, which would bring together GP, nurses and services traditionally only provided in hospital. Today's report made no mention of these plans, which will be set out in another report on primary care on Thursday.
Improving the workforce
A separate report, A High Quality Workforce, sets out plans to improve workforce planning, education and training. This includes setting up NHS Medical Education England - a new body to oversee workforce planning for doctors and dentists.