Tom Smith analyses reactions to the Darzi report.

Less than 24 hours after the publication of the Next Steps Review the early signs are that the Darzi review is moving the NHS reform debate forward. This is not to say it has resolved the problems - as many commentators are saying, what matters is how these ideas are taken forward. Nevertheless, the report is beginning to change the terms of the debate. Early reactions show support for the ideas being put forward, but they also suggest that appetite for grand plans are diminishing. If nothing changes this time there could well be more fundamental discussion about the future of the NHS to follow. In last night’s Newsnight special, for example, it took just ten minutes before the gathered experts were talking about the sustainability of the current funding model.

A special Newsnight discussion

The Newsnight special was hosted from a surgery in Leicester. The audience was full of health policy notables: Allyson Pollock, Julian Le Grand, Karol Sikora, Hamish Meldrum and Ben Bradshaw (not sat next to each other), Gerry Robinson and a range of others.

Ben Bradshaw was positive about the Darzi review, noting that even the BMA had given the report a lukewarm response – “and they are not the most enthusiastic supporters of government policy”. Speaking next, Hamish Meldrum thought it was “a shame that Ben wants to get into a sidefight”. He said the Darzi review contained fine words, but he admitted to some “scepticism – maybe even cynicism” about whether they will be realised. What will make the difference, he said, is whether staff in the NHS are really engaged.
An RCN representative also liked what she saw, particularly the chance for greater control. She agreed, however, the proof of the pudding is in the eating and how the plan is implemented.

It was interesting that at this stage, 10 minutes into the programme, the audience couldn’t stay on the topic of the Darzi review. They couldn’t resist the temptation to broaden the discussion.

Andrew Lansley didn’t dismiss the report out of hand, making it clear his problem is more with the government who, he suspects, is incapable of letting go. “We need a vision of what we want to achieve and where we want to go”. He talked about disease and cancers where our survival rates do not compare well. “We have to move beyond ensuring we provide care and ensure we provide excellent care”.

Norman Lamb said he would like to see a much more locally responsive NHS. He wants to see “local democratic accountability”. He was sad to see that mental health did not feature more prominently in the report.

Ben Bradshaw said he did want to achieve greater localism, but reserved his argumentativeness for Andrew Lansley – “targets do matter, but we want much greater decision-making at the local level”.

Gerry Robinson repeated his desire to get politics out of the NHS. Ben Bradshaw said “you just can’t take politics out of a £100bn tax-funded service”. Gerry said politicians should set the framework but not try to manage the detail.
Gavin Estler wondered out loud whether innovation was possible. The Newsnight host said people told him that “people who innovate get slapped down”. He asked the boss of Leicester PCT if he felt this way. He said he didn’t and was glad his “neck was on the line”.

The conversation then turned to Karol Sikora, social insurance and co-payments. Norman Lamb said not allowing them was unfair and Andrew Lansley jumped in to say the real issue is that in other European countries drugs like Avastin are available , so why not here?” “There are wider issues”.

So what did today’s press make of the report?

There was an interesting focus on incentives in all of the papers. The main issue for the Telegraph is that the plan will make it easier for patients to switch GPs. Their practice will not have to be in their neighbourhood and information will be available to improve choice.

Jon Appleby writes an analysis piece of the Darzi report and predicts that we will see much greater differences emerge between SHAs. The risk, he says, is that the government may be replacing one form of post-code lottery for another. Like others, he says the challenge is to implement this vision. In summary, he says the Darzi review may not be the answer to all our problems, but is undoubtedly a step in the right direction.

The Guardian’s John Carvel led on the information that will be available to patients on the quality of care. He also highlights the right to choose a GP and a hospital and the introduction of incentives to support this. Though much of this has been there already, Carvel thinks the placing of this in a Constitution is a signal that they want much stronger competition.

Polly Toynbee is extremely supportive – For all the hyperbole, Bevan would have approved of this.

‘Here, for once, is a modest, wise and practical new direction that centres on what patients feel and on how doctors and nurses can best use their discretion and expertise to improve the way the real-life NHS treats real-life patients. ‘This time there is no Alan Milburn or John Reid proving their macho credentials by tugging on the big "reform" levers from Whitehall’. Toynbee says the Constitution does matter because ‘it cements Labour's principles into the NHS with rights and promises for the next 10 years’.

The FT describes the Darzi report as ‘the world’s most ambitious attempt to raise the quality and effectiveness of an entire nation’s healthcare’. The highlight is to the change in incentives with a growing interest in ‘pay for performance’ schemes for hospital. The paper reports some cautionary remarks. Alan Maynard believes that payments for quality in secondary care could ‘discourage clinicians from providing data that they no yet believe will be reliable’. Sir Ian Kennedy said more work was needed to understand outcomes outside of surgery, in medical and mental healthcare.

There is going to be a lot of discussion about how this care will be measured.

In the Times highlighted the plan for provider income to be linked to patient satisfaction rates. It reports Lord Darzi’s comments in yesterday’s briefing and a his view that increases in income should feed down to clinical departments. “We will provide bonuses for organisations who are providing good-quality care and we expect that to filter down to the departments that are leading that innovation in care.”

One of the key themes in the report is to encourage clinically-led innovation – yet this theme hasn’t made it through to the day’s newspapers.

All in all, Darzi will be pleased with the reception to his report. The challenge for the coming weeks is for the government to convince the NHS that it is serious about devolution.