When Lord Darzi asked the NHS to come up with regional plans, managers found themselves in uncharted territory. A year on, HSJ has looked around the country to see how they fared

Just over a year ago, health minister Lord Darzi put the local NHS at the forefront of health service reform by tasking primary care trusts, providers and strategic health authorities with creating plans for their areas.

This approach was something of a cultural shift for the NHS - when HSJ surveyed managers eight months later, 56 per cent said they felt unable to influence the way health policy was implemented locally.

But perhaps more tellingly, 70 per cent said NHS managers in general had not made enough of the opportunity to look out not up, to coin NHS chief executive David Nicholson’s phrase.

A year on, work has begun on delivering the local visions which Lord Darzi’s review brought into being.

HSJ asked managers and clinicians across England what they had achieved and learned as a result of the increased focus on localism.

NHS EAST OF ENGLAND

Cambridgeshire Community Services chief operating officer Matthew Winn

“Two areas I would highlight stemming from the East of England regional strategy are children’s services and end of life care.

“In children’s services we’re focusing on transition care for children with long term conditions and disabilities and, for end of life care, providing care in people’s own homes.

“Giving these areas a local focus enabled [the emergence of] lots of good clinical leadership.

“The combination of local and national input has been a strength of the process - national strategies are evidence based and you’d be stupid if you didn’t use the that work and adapt it for the local situation.

“The Darzi process has let people translate rather than reinvent. With the expected reduction in NHS expenditure, we’re going to have to do much more [local] redesigning and collaboration to drive out inefficiencies and improve quality. This is where it becomes reality, we need to do more about it on a local basis.

“It’s quite exciting - the combination of reduced revenue and the different mindset of the Darzi review will accelerate service redesign.”

NHS LONDON

St George’s Healthcare trust clinical director Matt Thompson

“I’ve been involved in the project to change how major trauma services are provided in London, which was a direct result of Lord Darzi’s work.

“If that can be agreed by the PCTs [proposals go before London PCTs next month] that will be a good example of local change.

“It will be a very significant change leading to a significant improvement in outcome for patients.”

NHS NORTH EAST

South Tyneside foundation trust director of business development and corporate services Helen Ray

“We were already ahead of the game in our patch, but we have [recently] seen the ball rolling more quickly.

“We have been given a lot of support from the SHA to run with innovative ideas.

“It is only the first year of what is a 10 year programme, but we are starting to see momentum now. I think we will continue to see that grow.

“There has been much more of an opportunity to work with our cluster of PCTs, for example on how the future of emergency care services will work and how acute providers fit within that structure.”

NHS NORTH WEST

Salford Royal foundation trust information manager Edd Berry

“We have been encouraged to do these things [innovation and improvement] for some time and it was good to see that message reinforced nationally.

“It is a cultural change and you naturally get a bit of resistance, so to have it reinforced is right. People are taking things much more seriously than they were around quality - it is permeating in a healthy way. The national drivers around quality are needed, but the more important thing is the work people are doing locally.”

NHS SOUTH EAST COAST

Royal Surrey County Hospital trust consultant radiologist Andrew Carne

“The Darzi principles are about what we can do as clinicians to make things better for patients - it empowers us to do that.

“We looked at our haematuria pathway with the idea of making it not only a better service for patients in terms of getting through the treatment quicker, but a much more robust diagnostic pathway. It’s much better for patients and is probably cost neutral.

“It’s been good getting clinicians and managers from different specialists together in one room.

“We have been given the ability to do something which is right for the patients, right for the hospital and right for GPs, but does not necessarily tick the box of a target.

“It’s been a long time since clinicians have had the voice to say ‘it’s about patients not targets’.

“It’s very refreshing.”

NHS SOUTH WEST

Plymouth PCT integrated programme lead Nick Cheshire

“We have established health programme groups to take forward the work outlined in Lord Darzi’s next stage review.

“The main emphasis over the past year has been within planned and acute care, where we have seen improvements in discharge planning, infection prevention and control and greater joined up service provision.

“Thanks to the greater clinical involvement through our health programme groups we have developed strengthened relations among our partners.”

NHS SOUTH CENTRAL

Oxford Radcliffe Hospitals trust finance director and deputy chief executive Chris Hurst

“To say we didn’t make the most of our links with local partners in our unsuccessful application to become one of Lord Darzi’s academic health science centres is fair criticism.

“It wasn’t a conscious decision, but you sometimes take for granted the things that are closest to you.

“I don’t think we did ourselves justice but it’s a test of character and one we’re rising to as we move our plans forward [to achieve academic health science centre status].”

“What we’ll want to be assured of is that we are describing our organisation’s strengths but also taking the arrangements forward in a way that aligns all local partners so they can contribute appropriately.”

NHS WEST MIDLANDS

Cardiologist and NHS West Midlands clinical engagement lead for staying healthy Kiran Patel

“The next stage review highlighted the need for prevention of disease to be everybody’s business as well as be mainstreamed. Such a philosophy would enable the NHS to deliver a paradigm shift from illness management to health preservation. National service frameworks have guided integrating preventive services into the care pathway and at a population level for many years, but development and implementation of these strategies has lagged behind more tangible and acute delivery of care.

The Darzi review has changed that. The acute sector is now also engaged. In Sandwell and West Birmingham Hospitals trust, all first degree relatives of patients admitted with a heart attack are invited to a clinic where cardiovascular risk factors are assessed and they are given advice on lifestyle change or referred into services such as smoking cessation. This model is now being rolled out across the region in order to exemplify a seamless service, accessible to all who require it, to prevent disease.”

NHS YORKSHIRE AND THE HUMBER

East Riding of Yorkshire PCT chair Karen Knapton

“Our five year health strategy has given us the focus to really hone in on what’s important to our community.

“We have opened a GP led health centre in one of our most deprived areas and invested more money in palliative care evening services and neighbourhood teams working 364 days a year. Early data shows the teams have kept people out of hospital.

“We still feel we are looking up more than we are looking out… because of the performance management from the SHA and DH - most of us want to say ‘just let us get on with the job’.

“In trying to change a service, we can come up with good ideas but working through what that means and starting out the tendering process, than can get quite frustrating. That’s just life in the NHS.”