Choice. Transparency.Quality. Reality? Can Darzi’s plans work?

Choice. Transparency.Quality.
Reality? Can Darzi’s plans work?

Lord Ara Darzi’s much-trumpeted plans for the NHS have finally been unveiled. Gordon Brown says they represent a ‘once-in-a-generation opportunity’ for the health service in the UK. Critics describe them as a ‘wasted chance to save the NHS as it turns 60’. Lord Darzi says his ‘visions’ are bold and ambitious. Consensus suggest they are well-intentioned. But are they implementable?

The NHS Next Stage Review, which outlines the Government’s plans to reform the NHS in England over the next 10 years, has been published. The review, led by health minister and cancer surgeon Lord Ara Darzi, follows a year-long consultation with patients, NHS staff and stakeholders, and promises to shift health service emphasis from increasing the quantity of care to improving its clinical quality. The 96-page review document, in one sense, represents a tidier presentation of the measures Darzi proposed in his two interim documents in 2007. But the latest fanfare announcement, designed to coincide with the NHS’s 60th birthday celebrations, comes with the wholesale endorsement of the UK Prime Minister and now moves from proposal to policy. The next phase is implementation.

How implementable the policies are and how likely they are to succeed is open to debate. The BMJ suggests that there is little by way of small print to flesh out the “elegant bones” of the report, while much of the British media appears sceptical that its virtuous aims will be realised. Whereas Gordon Brown described the review as a “once-in-a-generation opportunity” to turn the health service into one of the world’s best health systems, one major national daily said the plans evoked the words ‘deckchairs’ and ‘Titanic’. Another broadsheet said the review promised “a classier NHS” but that patient choice – a central component of the new plans – was “still an illusion”.

So what are Lord Darzi’s plans, and what do they mean for pharma? This month, Pf presents the first of two overviews of the NHS Next Stage Review. In the coming months, we will look in more detail at the various aspects of the new policy and its implementation, and assess its likely impact for the pharmaceutical industry. For now, we focus on two of the main headlines from the Review – the NHS Constitution and the improvements made to the NICE process.

According to Lord Darzi, the NHS Next Stage Review is the culmination of a process that sought opinion from over 2000 clinicians and health and social care workers from every NHS region in England. This process, he said, highlighted significant regional variations in the quality of care provided and led to the conclusion that tackling this should be the first priority. A glance at the History of the NHS timeline in this issue of Pf reveals that similar variations in the provision of care were noted and ‘addressed’ in previous Government reports dating back decades. The present-day mantra remains the same: “The NHS needs to be flexible to respond to the needs of local communities, but people need to be confident that standards are high across the board,” said Darzi. “Delivering (our) visions will mean tackling head on those variations in the quality of care and giving patients more information and choice.”

NHS Constitution and Patient Choice

It is the notion of choice that lies at the heart of the Review. Under the terms of a draft NHS Constitution, patients will be given a new legal right to select a GP practice and to choose between different types of treatment available to them. The NHS, said Darzi, will expand the family doctor service to provide ‘genuine choice’ between GP practices and give more information about the range and quality of care on offer. The constitution will also guarantee patients’ rights to choose a hospital and to select the type of treatment they want. Hospitals will be required to publish a range of quality indicators – from waiting times to surgeons’ patient death rates and patient satisfaction. Patients would not, however, be entitled to choose between individual surgeons in an NHS team. “By measuring quality across the service and publishing that information for the first time, both staff and patients can work together to make better informed choices about their care,” said Darzi.

In summary, the draft NHS Constitution gives a series of legally enforceable rights and pledges to patients and health service staff. For patients, it promises the right to:
• Receive NHS services free of charge, with the exception of certain limited treatments sanctioned by Parliament
• Access local NHS services and not be refused access on unreasonable grounds
• Expect your local NHS to assess the health requirements of your local community and to put in place the services to meet those needs
• Make choices about your NHS care and be given the information you need in order to do so
• Have a say in the planning and development of local services
• Have access drugs approved for NHS use, if recommended by your doctor, and the right to an explanation of all decisions made about funding your treatment.

NICE appraisals to be accelerated

The final point in the list above signals a clear intent to improve patient access to medicines and is one measure designed to tackle the variations in care currently evident across the country. In its patient leaflet describing the draft NHS Constitution, the Department of Health says that the right to access drugs approved on the NHS, and the entitlement to explanations of all funding decisions will lead to an NHS where decisions are “clear and rational” rather than a “lottery of access”. Such bold and ambitious aspirations have been welcomed by the pharmaceutical industry and patients alike, and follow longstanding allegations of ‘postcode prescribing’ within the NHS and criticism of the motives of the appraisal processes that lead to funding decisions.

Following Darzi’s Review and the publication of the draft NHS Constitution, this appraisal process will be dramatically accelerated. Currently, the average lead time a NICE appraisal takes is around two years – under the new proposals, this will be cut to just six months. Patients will be guaranteed a right to drugs and treatments approved by NICE and can also expect local decisions on drugs with NICE appraisals pending to be made rationally, following proper consideration of available evidence.

NICE itself will be expanded to set and approve more independent quality standards, while a new National Quality Board will offer “transparent advice” to Ministers on what priorities should be for clinical standard-setting by NICE.

The ABPI has welcomed the measures to improve access to modern medicines, and says the challenge now is to deliver them. Dr Richard Barker, Director General of the ABPI, said: “Collectively the measures announced by Lord Darzi represent the basis for a huge leap forward in driving the use of the best available treatment, including the uptake of NICE guidance, across the UK. The task is now to deliver on the promise, so that people across the UK have full and fair access to innovative, life-extending medicines, demonstrated to be clinically-effective and cost-effective.”

The ABPI says the news is good both for patients and for the pharmaceutical industry. “Patients can now look forward to receiving the same standard of care wherever they live, rather than on the basis of a postcode lottery,” said Dr Barker. “Britain’s innovative pharmaceutical industry will also gain, by serving a more innovative customer, one that will also be a more attractive location for future clinical trials – a further benefit for UK patients.”

Chris Brinsmead, President of the ABPI, said that the measures offered the opportunity to effect a “seismic change in patients’ rights” to access the best and most modern medicines based on clinical need. The challenge ahead, he said, would be to ensure that the opportunity is realised; he added that the ABPI would be working in partnership with the Government and other stakeholders to that effect.

Clearly, Lord Darzi’s plans are indeed ambitious and well-intentioned. The wider challenge is to turn the rhetoric into reality. Next month, we take a further look at the NHS Next Stage Review, including an examination of Darzi’s ‘Vision for Primary & Community Care’. We will also look in more detail at how various NHS stakeholder organisations have responded to the announcements.