NHS care quality pledge after Darzi review

The Government pledged to put quality at the heart of patient care today as health minister Lord Darzi set out his vision for the NHS.

His long-awaited report outlined measures to raise standards of care but also to increase choice over how and where patients are treated.

It includes plans to force all hospitals to publish "quality accounts" of the care they provide in the same way the publish financial accounts.

Patients' assessments of the care they receive will also be linked to hospital funding, with hospitals offering poor care having their incomes reduced.

For a district general hospital around £7m to £9m a year will be dependent on factors like outcomes and patient satisfaction.

In his introduction to the study, Lord Darzi said: "For the first time, patients' own assessments of the success of their treatment and the quality of their experiences will have a direct impact on the way hospitals are funded."

Many of the details in today's report have already been announced including the speeding up of drug appraisals by the National Institute for Health and Clinical Excellence (Nice).

Personal health budgets for people with conditions such as diabetes or multiple sclerosis will also be piloted to give patients greater control over their care.

There is a focus on preventing ill health, with the creation of a Coalition for Better Health, which will initially look at tackling obesity.

The 12-month review involved consultations with 60,000 patients and staff and has been hailed by the Prime Minister as a "once-in-a-generation opportunity" to make the NHS one of the world's best systems.

The report was accompanied by the publication of an NHS Constitution, setting out a patient's "rights and responsibilities".

The document, which is open to consultation, includes rights to local NHS services, to seek treatment in the rest of Europe if faced with an "undue delay" in England, and the right to drugs and treatments recommended by Nice.

Other rights include the right to choose a GP practice and the right to express a preference for choosing a particular doctor.

But some areas of the Constitution only lay down "pledges", including striving to ensure services are "provided in a "clean and safe environment" and striving to respond to complaints quickly.

For an average district general hospital in England with a budget of about £250m, between 3 per cent and 4 per cent of that budget could be made up from how well it performs on quality.

The report said: "We will make payments to hospitals conditional on the quality of care given to patients as well as the volume.

"A range of quality measures covering safety (including cleanliness and infection rates), clinical outcomes, patient experience and patient's views about the success of their treatment will be used."

Regarding choice, a spokesman for the Department of Health said GP surgeries had to make all "reasonable efforts" to accommodate a patient's choice of doctor and could only refuse on the grounds of capacity.

But it was down to each individual hospital whether they allowed patients to choose which individual surgeon treated them, he said.

Lord Darzi said the country was now moving into a decade "where patients" experience will have a significantly higher weighting than it ever has before.

"This is about giving more clout to patients, more say to patients."

Health Secretary Alan Johnson said the NHS was in much better shape than 10 years ago and welcomed the report.

"These locally driven, clinically-led plans show how quality of care will be raised right across the country, with doctors and nurses supported to offer big improvements in treatment at the bedside. Quality of life will be improved and more lives saved."

Sir Ian Kennedy, chair of the Healthcare Commission, said: "This has a real chance of helping to improve the quality of care that patients receive.

"The proposals should be given a fair wind - they deserve one.

"While we welcome the objectives of this review, it is essential to have an independent assessment of progress. The document is somewhat short on how this will come about and the role of regulation. We will be raising this with the Government."

Dr Mike Knapton, director of prevention and care at the British Heart Foundation (BHF) said: "The BHF welcomes Darzi's emphasis on improving patient experiences as well as clinical effectiveness throughout the NHS, particularly his emphasis on improvements in end of life care for heart patients.

"People living with heart disease tell us they want better personal communication with NHS professionals and improved integration of health and social care.

"We will watch and see if today's announcements will make a difference, with greater clarity about what patients can expect from the NHS."

Gordon Lishman, director general of Age Concern, said: "Older people are the biggest users of the NHS, yet services are not currently set up to meet their needs. Measuring performance based on what older people think will help to improve the quality of care they receive."

Unite national officer for heath, Karen Reay, said: "We welcome the general tenor of Lord Darzi's report that the future emphasis should be on the whole patient/client experience in the NHS - from the quality of the consultants' care to the standard of the food - rather than the crude managerial targets of recent times."

Shadow Health Secretary Andrew Lansley, said: "The complete lack of vision in these proposals means that, sadly, the Government has missed its 'once-in-a-generation opportunity' to enact the real reform that our NHS needs.

"Instead of scrapping the targets which distract doctors from delivering the best possible health care, Labour have opted for more of the same.

"It's no good talking about focusing more on health outcomes if doctors and nurses continue to be micro-managed by bureaucrats in Whitehall and their local strategic health authorities.

"What health professionals want and need is for politicians to stop interfering and to allow them to do the job they were trained to do."

Simon Gillespie, chief executive of the MS Society, said: "The emphasis on personal budgets and patient empowerment means this report represents a great opportunity to give people with MS access to the care they need when they need it and in the most appropriate way.

"MS is a fluctuating and complex condition and people's needs change from week to week.

"Putting people at the heart of planning and delivery of their own healthcare should lead to a better quality of life overall and encourage greater independence, as we have seen when personalised social care has worked."