Ahead of publishing the majority of the much-anticipated Darzi Review, the Government has published in draft its NHS Reform Bill.

The new Bill’s aim is “to take forward those proposals arising from Lord Darzi’s ‘NHS Next Stage Review’ of the NHS in England that would require legislation to enable their implementation”, according to the Office of the Leader of the House of Commons' website.

It suggests that the key elements of a Bill might include publishing “an NHS Constitution to reinforce the core purpose and values of the NHS and to introduce measures to make the NHS as effective at preventing ill health and promoting wellbeing as it is at cures”.

Proposals also include plans to enable and encourage primary care trusts (PCTs – the NHS local administrative units) “to be more responsive to their local communities and to strengthen public involvement in PCTs’ commissioning arrangements”; and plans to give greater scope for patients to shape the care they receive by allowing patients greater control over the management of their care.

The practical implications are wide-ranging. The final point and PM Gordon Brown's subsequent comments indicate that the argument for giving individual budgets for patients with long-term conditions (such as diabetes, asthma or mental ill-health) has won the day. This approach has been tried for certain aspects of social care, with some success and much popularity.

Performance-related pay for hospitals
PM Gordon Brown also outlined another, little-anticipated new aim to review the national ‘payment by results’ system. Mr Brown told the House of Commons, "for the first-time payments to NHS hospitals will be adjusted according to patient satisfaction and health outcomes."

Analysts quickly pointed out potential flaws in the payment for performance approach. Kings Fund chief economist Professor John Appleby pointed out to BBC News that the proposal risks "putting PCTs in a situation where they have a choice of paying to give fewer patients top quality care or more patients average care. It puts them in a difficult position."

However, Steve Barnett, acting chief executive of the NHS Confederation, said: "The NHS needs to focus more on patient experience and health outcomes and a review of the payment system will be a helpful step in realising this."