Darzi’s key themes
Gordon Brown welcomed the Darzi review as a “once-in-a-generation opportunity” to make the NHS one of the best healthcare organisations in the world. The major changes for patients appear to be:
- The right to “choose”; whether that be the local GP or a nominated surgeon
- A move towards ending the drug “postcode lottery”
- A shift towards delivery in the primary care sector (including the encouragement, though not the obligation, for the development of polyclinics)
- More emphasis on public health schemes
We also point to some key issues to address for PCTs and trusts.
Is Darzi targeting the right areas?
We have discussed most of these in past issues of the CHN. On the whole, Darzi’s reforms seem sensible…
Public health is a no-brainer. Similarly, ending the erratic provision of drugs can only be considered a sensible change.
The shift towards primary care can also provide real benefits – although PCTs need to think very hard about how to achieve the best results, in both commissioning and providing. From some conversations we gather PCTs are struggling, perhaps more so on how to develop their provider arms. In turn, trusts need to establish how to react to an encroaching private sector.
Commercialisation will drive improvements
How will choice affect the commercialisation of services? Some view the increasing commercialisation of the NHS as a danger; we believe it encourages many positive changes. Allowing patients to choose will force primary and secondary care providers to compete. This should drive efficiency, innovation and ultimately improvements in the patient experience.
But a little restraint or more thoughtful reorganisation may be required – the ethos of the NHS, the universal obligation to provide accessible free care to all, remains paramount. We’ve seen the Post Office exposed to private competition and get itself into a dire financial mess (to the extent it fears for its position to provide a universal service). Notwithstanding, increased competition, handled correctly, is, in our view, the right way forward.
All in all, we like what Darzi is saying – and most reaction has been positive. However, a major issue remains – how is all this going to happen?
Good on ideas, lacking on implementation?
Although Darzi has picked on the key areas of NHS reform, the report makes very few practical recommendations for delivery. It includes no masterplan for the reorganisation of services.
Choice requires information, but we are not sure that the required IT is in place (yet). How will the “quality accounts”, to sit alongside the financial balance sheet, actually be compiled? Can NHS Choices provide all the information the public may want?
We have been championing the power of information (and the ability to analyse it) for a while now. There are now some very real cash incentives for hospitals to understand their own business; 4% extra funding can be secured from a better quality of care. Further, a well performing hospital will succeed in the new competitive world, an underperforming one will not.
Implementation plans also need to be drawn up for primary care provision, for polyclinics, for public health schemes – well, for pretty much everything. So although a good start, we think Darzi’s review is only the beginning. Who will drive change and how will it be achieved, is where the hard work begins.
A lack of clear guidance on implementation means that PCTs and Trusts need to start thinking about the implications for them. Here at Credo, we have summarised some of the key issues to think about:
PCT (Commissioning)
- NHS comparators indicates where we’re weak, but how do we improve our commissioning strategy in those areas?
- How can we judge the impact of interventions we put in place?
PCT (provider arms)
- What is the best structure for our provider arm?
- What role can the private sector play?
- Where do we fit public health into the equation?
Trusts
- Should we specialise, if so, where?
- How can we influence GP referral patterns?
- What shape will competition take?
