News
NHS reforms to focus on quality
2 July 2008
The next set of NHS reforms are to focus on quality of care, according to
Lord Darzi's report on the future of the NHS: High Quality Care for
All, the NHS Next Stage Review Final Report [1]. The report gives a
grand overview of the path the NHS is to take to improve quality for
patients and the public, organisations and staff at all levels, with details of implementation
to be produced by several workstreams over several months after further consultation with
'stakeholders', and accompanied by impact assessments.
High Quality Care for All was published along with a 'note' on the impact
and equality impact assessment
of all the proposals contained in the report [1], and the policy
proposal and impact assessment from the workstream on workforce planning education and training [2]. It also included the
launch of a draft NHS Constitution [3], which is open to consultation until
17 October 2008.
Further workstream policy proposals and their impact assessments will be published
soon: Our Vision for
Primary and Community Care (due 3 July) and A Health Informatics
Review Report (due 10 July), which is, for the health informatics
community, the long-awaited report started by Professor Matthew Swindells,
until June the Interim Chief Information Officer for the Department of
Health, and now Managing Director for Health at Tribal.
A crucial part of the reforms is devolving decision making to the
regions. Over the last few months England's ten strategic health authorities
(SHAs) have published their visions for the future of healthcare in their
regions for the next ten years — based on local consultations on the local priority
health needs [4].
A key focus of the report's recommendations and the local SHA plans
is keeping people healthy and giving patients more control over their own
healthcare.
Every primary care trust is to commission
comprehensive wellbeing and [illness] prevention services, in
partnership with local authorities. Six health areas are targeted: obesity, reducing alcohol harm, treating drug addiction,
reducing smoking rates, improving sexual health and improving mental
health. The report says that the services offered will be "personalised to meet the specific needs of
their local populations".
This, however, seems a contradiction in terms. By definition, meeting
the needs of a population is not personalised, and in an environment of
restricted budgets and personnel, targeting six health areas means
people with other health needs will not get the same level of care.
Included in giving patients more control over their healthcare are:
more information on GP practices to give greater choice; fairer funding
for GPs, and those that give more "responsive, accessible and high
quality services" to get more funds; the NHS constitution (at least the
draft) will give patients a right to choose treatment and providers, and
to information on quality of healthcare.
There will be personalised care plans for people with chronic
conditions — to be provided to 15 million people over two years — and personal health budgets will be piloted for social care
"where this makes most sense for particular patients in certain
circumstances".
In a change that dominated the news, patients will be guaranteed
access to NICE-approved drugs and treatments — where recommended by a
clinician.
To help improve safety and reduce healthcare associated infections
the Care Quality Commission will have stronger enforcement powers.
NICE will be expanded to set independent quality standards and a new
National Quality Board will be established to advise ministers on the
quality-related priorities that NICE should investigate.
The quality of care at all levels, safety and clinical outcomes will
be systematically measured and the information published. The
measurement will include patient's views on their treatment and care
experiences. This has huge implications for gathering and administration
of data, which will have to be done automatically by IT systems to be
efficient and cost-effective. Without modern patient record, clinical
audit, etc, systems in place at all levels of care, and transfer of data
between care providers, this will be impossible.
Funding for hospitals will also be related to the quality of care
provided, which will include patients' assessments of quality. The
report does not say whether this will apply to polyclinics, which have
been guaranteed payment based on forecasts of numbers of operations
needed and are paid whether or not the operations are actually carried
out.
Healthcare staff and organisations will be given more freedom to
focus on quality. Frontline staff will be given more freedom and powers
to control quality of care and will be freed from central control.
Practice based commissioning will be 'reinvigorated' to enable GP
practices to develop more integrated services for patients involving
other primary and community organisations.
There will be more foundation trusts, which already have greater
control over their affairs. Community care providers will also be given
similar freedoms to control the quality of care including creating
community NHS foundation trusts. There will be pilots of integrated care
organisations that bring together health and social care organisations.
Several measures are announced to improve the work environment and
the planning, commissioning and provision of education. Technical
details were published alongside the report in A High Quality
Workforce: NHS Next Stage Review [2].
The constitution will set out "the enduring principles and
values of the NHS, and the rights and responsibilities for patients,
public and staff". Its aim is to empower patients, the public and NHS
staff, create a shared purpose, values and principles, and strengthen
accountability through national standards for patients and local
freedoms to deliver.
The report proposes that all organisations providing NHS services,
including contracted private sector organisations, will be obliged by law to
take account of the constitution in their decisions and actions.
There will be a Constitutional Advisory Forum to bring together
representatives from patient, clinical and managerial communities, to
oversee the consultation process. The Forum will work with the NHS to
lead a process of engagement in every region of England. The
Consultation is open until 17 October. Consultation documents and
contact details are available on the Department of Health website [3].
Further information
1. High Quality Care for All: NHS Next Stage Review Final Report.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_085825
2. A High Quality Workforce: NHS Next Stage Review
www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_085840
3. A consultation on the NHS Constitution (open till 17 October
2008).
This gives details where to send opinions and has consultation documents
that can be downloaded.
www.dh.gov.uk/en/Consultations/Liveconsultations/DH_085812
4. The local reports from the 10 Strategic Health Authorities.
Southeast Coast SHA
Healthier people, excellent care
www.southeastcoast.nhs.uk/hpec/index.asp
South Central SHA
Towards a healthier future — A ten year vision for healthcare across NHS
South Central
www.southcentral.nhs.uk/page.php?id=249
East of England SHA
Towards the best, together
www.eoe.nhs.uk/page.php?page_id=66
South West SHA
Improving Health. Ambitions for the South West
www.southwest.nhs.uk/pdf/
NEW%20NHS%20Ambitions%20Brochure%2014_05_08.pdf
(downloads document directly)
London SHA
Healthcare for London. Consulting the Capital
www.healthcareforlondon.nhs.uk/pdf/consultingTheCapital.pdf
(downloads document directly)
West Midlands SHA
Delivering our clinical vision for a world class health service
www.westmidlands.nhs.uk/cms/InvestingforHealthStep2/
tabid/714/Default.aspx
The page has a range of national and local reports, including this
title.
East Midlands SHA
From Evidence to Excellence
www.eastmidlands.nhs.uk/welcome/our-nhs/vision-document
Yorkshire and the Humber SHA
Healthy Ambitions
www.healthyambitions.co.uk/index.html
This report has a whole website devoted to it!
THe SHA website is at
www.yorksandhumber.nhs.uk
North West SHA
Healthier Horizons for the North West. A new vision for healthcare in
the northwest — Better Care, Better Health, Better Life
www.northwest.nhs.uk/healthierhorizons/
North East SHA
The main report: Our Vision, Our Future. Our North East NHS
A strategic vision for transforming health and healthcare services
within the North East of England; and the reports for the eight
clinical pathway groups can be downloaded from this page:
www.northeast.nhs.uk/publications-and-reports
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