High quality care for all, Lord Darzi’s next stage review, was published on 30 June 2008. The review involved thousands of clinical, social care and health service professionals, and members of the public. The purpose of the report was to focus on what the NHS could do to improve the prevention of ill health in partnership with other authorities and agencies. At the heart of the report was a focus on quality, which was defined as safe, effective and efficient care. Darzi announced seven steps that would be needed to achieve higher quality care:
- bringing clarity to quality: developing a coherent approach to setting standards
- measuring quality: developing a quality measurement framework at every level
- publishing quality performance: making data widely available
- recognising and rewarding quality: ensuring the right incentives are in place
- raising standards: developing stronger clinical leadership
- safeguarding quality: providing reassurance to the public through effective regulation
- staying ahead: supporting innovation in the NHS.
At a provider level, Darzi outlined plans to require NHS providers to publish quality accounts from April 2010 in the same way as they would publish financial accounts. The reports would provide information for the public on safety, experience and outcomes.
The report was also notable for introducing the concept of ‘polyclinics’. The report outlined plans to open over 150 GP-led health centres that would provide a range of services such as diagnosis, mental health, sexual health and healthy living services.
With regard to regulation, the review highlighted the role of the new joint regulator – the Care Quality Commission (CQC). The report noted that the CQC would have increased enforcement powers compared with its predecessor regulators, suggesting that the CQC would have a stronger focus on compliance and more flexible powers to deal with those providers not meeting registration requirements.
Darzi proposed a stronger role for the National Institute for Health and Clinical Excellence (NICE). The review suggested that all patients would receive drugs and treatments approved by NICE where recommended by clinicians. NICE’s role would also be expanded to set and approve more independent, quality standards.
Darzi articulated the importance of focusing on outcomes rather than targets. The proposal was that targets such as 18-week waits that were once considered aspirational would become established as minimum standards. In the future, national challenges would be met through minimum standards and commissioning decisions. There would not be additional top-down targets beyond the minimum standards.
The review addressed a number of areas relating to the commissioning of NHS services.
A renewed focus on practice-based commissioning
The review outlined the government’s commitment to reinvigorate practice-based commissioning (PBC) and committed to providing strong support for PBC by providing incentives for clinicians to be involved in commissioning. The government stated that it would act to hold PCTs to account for the quality of their support to practice-based commissioners.
Integrated care organisations
The government committed to piloting new integrated care organisations (ICO), which were intended to bring together professionals from both health and social care to achieve more personalised, responsive and coordinated care.
The paper set out the government’s intention to reflect quality in tariff payments. Payments to providers would be dependent on the quality of care provided as well as the volume of services. Quality indicators such as safety, clinical outcomes and patient experience would be used. This payment was known as commissioning for quality and innovation (CQUIN) and was expected to encourage NHS organisations to give quality of care greater regard. The scheme would be an ‘overlay’ on payment by results.
The NHS constitution
The government also committed to introducing a new right to choice in the first NHS constitution. The draft NHS constitution included rights to choose both treatment and providers and to have access to information on quality to support informed choice.
World class commissioning (WCC)
The report set out that those primary care trusts that had demonstrated they were improving health outcomes would be given greater freedom over the priorities they set and the methods, people and approaches they employed.
The next stage review included a number of commitments relating to the expansion of patient choice, including:
- the extension of GP practice choice and improved information through NHS Choices
- the introduction of a new right to choice (both of treatment and of providers) supported by a right to access information on service quality in the first NHS constitution
- personalised care plans for those with long-term conditions
- pilots of personal health budgets and direct payments
- a guarantee that patients would be able to receive drugs and treatments approved by the National Institute for Health and Clinical Excellence (NICE) when recommended by a clinician.
The review also committed to implementing a wide-ranging programme to support the development of vibrant and successful community health services and a commitment to support staff to set up social enterprises.