Managers put faith in Darzi's clinical vision

Lord Darzi at the launch

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Managers believe Lord Darzi's vision for the NHS, where quality is financially rewarded and commissioning is the lynchpin of the service, is achievable within the next 10 years.

The culmination of the year-long next stage review came this week with the publication of his report High Quality Care for All and the accompanying workforce and primary and community care strategies.

It set out plans to reshape aspects of primary care and shines a spotlight on the neglected community care sector. Patients will be given more power and providers opened up to greater scrutiny.

As revealed by HSJ, NICE's role will be boosted and it will be expected to speed up its advisory work and provide a wider range of information.

A draft NHS constitution was also published for consultation, enshrining patients' right to choice and to receive drugs where backed by NICE and deemed clinically appropriate by a doctor.

All patients will have a right to be treated with "dignity and respect" and to be given a professional standard of care by appropriately qualified and experienced staff in a clean and safe environment.

Lord Darzi stressed the need for more clinician managers and pledged to set up a pool of the 250 most promising leaders of tomorrow, who will receive special career development.

There was widespread support for the surgeon's plans, although few felt they were radical.

A snap poll of 205 HSJ readers revealed that the vast majority think Lord Darzi's vision of clinically led, patient centred care is achievable within the next decade - half of those within the next five years.

Now that the report has been published, more than a third said reporting on the quality of services would be their top priority. Empowering clinicians will be the focus for around a quarter of readers.

Half thought the workforce strategy's boost for clinician managers and emphasis on streamlining training would lead to a stronger, more appropriately skilled workforce. Just over a quarter said they did not agree; 23 per cent said they did not know.

The constitution was a success, with 93 per cent of respondents saying the seven guiding principles it set out represented their beliefs. Forty-three per cent said its proposals would empower staff; 33 per cent said they did not think they would.

Commenting on the review overall, 56 per cent said it made them more committed to the ideals of the NHS, 30 per cent said they did not know and 14 per cent said it made them less committed.

When it came to patients, 39 per cent believed the review empowered patients, with 32 per cent remaining unsure. Forty-seven per cent said the review would improve healthcare for patients, 40 per cent were unsure and 13 per cent said they thought it would not.

Speaking to HSJ about the report, NHS North East chief executive Ian Dalton said it took patient choice to "a new level".

"It is the start of what we will look back on as a revolution in how patients are genuinely empowered," he said.

Professor of social policy at the LSE Julian Le Grand said: "It's not pressing future, major, radical reform and that's good."

But the Nuffield Trust warned that the report lacked important detail. Director Jennifer Dixon said: "The report is much longer on the 'what' than on the 'how'."

Royal College of Surgeons president Bernard Ribeiro said: "The problem will come in the implementation, as always.

"So, top marks for identifying the problems and finding strategies for how it might be organised but at the moment we are waiting to see how it will actually be implemented."

Next stage review at a glance 

• New constitution to enshrine rights and responsibilities of the NHS, staff, patients and the public

• NHS to deliver high-quality personal care to all patients, not just those who shout loudest

• New focus on promoting good health, including services for people at work

• Clinical staff to be free to offer safest and most clinically effective services

• Providers to be rewarded for good clinical outcomes and penalised for poor outcomes

• All providers to publish annual quality report, putting quality on a par with finance

• Choice to be extended to GP services

• Personal health budgets to be piloted

• Personalised care plan for everyone with a long-term condition

• PCTs to fund drugs approved by NICE where clinicians recommend them

• NICE to speed up approvals process

• New focus on clinical leadership

• Tariff to be based on best practice not national average

• More influence for SHAs

• No GMC for managers

• No new national targets

• Foundation trust process to speed up

Costs at a glance

• Faster National Institute for Health and Clinical Excellence processes and increased uptake of drugs: £100m

• Strategic health authority innovation for clinicians: £150m

• Collecting patient reported outcome measures: an official estimate is £3-£6 per patient

• Staff bonuses when organisations hit surplus. Gloucestershire Hospital gave 14 per cent of its surplus to staff, or £232m nationally, in 2007-08

• NHS Evidence best practice portal: £25m (NICE estimate)

• PCTs to provide practice based commissioners with a management allowance as standard

• New resources for areas with worst obesity and alcohol abuse

• Phase out GPs' minimum practice income guarantee: around £330m. To be negotiated

• Quality and outcomes framework reform with more outcome measures

• Commissioning for quality and innovation framework and best practice tariff to base up to 3 per cent - around £1bn - of hospital income on quality targets and patient reported outcomes

• Individual healthcare budgets for people with long-term conditions

• PCTs to withhold payment for "never events" such as serious safety breaches

• Mental health tariff by 2010-11