Darzi launches 10-year vision for the NHS

Health minister Lord Darzi has set out his vision for an NHS focused on quality of services, where patients' wishes come first and nurses and doctors have the freedom to offer the safest and most effective treatment.

High Quality Care for All , published today, promises a new and expanded role for the National Institute for Health and Clinical Excellence, which will be expected to make more rapid appraisals of new drugs and set national quality standards. Primary care trusts will have to fund drugs approved by NICE.

Implementing this broad ambition will require radical changes to payment methods, data requirements and accountability mechanisms.

The report, endorsed by health secretary Alan Johnson and prime minister Gordon Brown, was published alongside a draft constitution setting out the basic principles of the NHS and the rights and duties of those who use it and work in it.

"The report also signals a move away from national tariffs with the introduction of 'best practice tariffs'"

Lord Darzi said: "This report will enable frontline doctors, nurses and patients - who provide and use NHS services - to put into practice their visions for high-quality care."

Payment systems will be "strengthened by reflecting quality in the payment mechanism and increasing individual control", it says.

For a start, payments to hospitals will be conditional on the quality of care as well as the volume under a new commissioning for quality and innovation scheme. Quality measures will include infection rates, clinical outcomes, patient experience and patient-reported outcomes.

The tariff uplift for 2009 will be held back for PCTs to start rewarding providers on quality from next year. In future, the tariff uplift will be set out for several years in advance.

The report also signals a move away from national tariffs with the introduction of "best practice tariffs" that take into account the cost of best practice and not just the average. These will start in 2010-11 for some treatments.

The review proposes devolving budgets to nurses and doctors and exploring personal health budgets for people with long-term conditions. A pilot programme will launch in 2009.

NHS providers will be required to keep track of new quality metrics that are to be developed with staff. The first quality indicators will be announced in December 2008 and by April 2010 healthcare providers will be legally required to publish "quality accounts" like financial accounts.

Darzi comes out in favour of a range of existing initiatives. World class commissioning, practice-based commissioning and moving acute, mental health and ambulance services to foundation trust status as fast as possible all receive ringing endorsement.

He stops short of directing PCTs to divest their provider functions, instead saying the Department of Health will support local decisions on the best way to achieve flexible, responsive community services.

However, he intends to introduce a new right for community staff to request to set up social enterprises to deliver services. PCTs would have to consider them and, if approved by the board, support their development and award them a three-year contract.

In a nod to joined-up services, the report calls for new integrated care organisations that bring together health and social care staff. Proposals will be invited shortly.

On accountability, Lord Darzi outlines new mechanisms based around overall outcome that reflects the entire patient pathway. However, no detail is provided.

NHS commissioners will be held to account on the quality of health outcomes they achieve for the populations they serve, including the most vulnerable, excluded and those with complex needs. The system will be built around the world class commissioning assurance framework.

For more breaking news on the Darzi review as it emerges, visit the news section on hsj.co.uk. For full coverage, read this week's HSJ and NHS 60 supplement