Health Minister Lord Ara Darzi’s Next Stage Review of the National Health Service is to be welcomed for including no proposals for major restructuring, following a “long process of deeply interconnected reforms”, the NHS Confederation has told Parliament.

Lord Darzi has “rightly avoided large big-bang changes in favour of more carefully-thought-through quality improvement,” although there is a danger here that policymakers will become impatient, Director of Policy at the Confederation, Nigel Edwards, told the first session of the House of Commons Health Select Committee’s new inquiry into the Darzi report on July 10. It is important that the NHS is left to implement these reforms, and other still in train, and is not subjected to further initiatives and reorganisations, he said.

Also addressing the inquiry was Niall Dickson, chief executive of the health policy think tank The King’s Fund, who told MPs that there were two significant omissions in Lord Darzi’s Review; it contains no estimates of cost or any indication of just how different the government expects the quality of health services to be in five or 10 years time.

There is also an “inherent tension,” said Dickson, in the government’s desire to establish national guarantees and standards, and in its pledge to get rid of the postcode lottery over NICE-approved treatments because strategic health authority plans and devolution to primary care trusts means some regional variation is inevitable. “The issue for the future will be how to balance what is acceptable variation to meet local needs and what it unacceptable in terms of quality of care,” he told the MPs.

While the policy of mandating funding of NICE-approved drugs was already in place, putting it into the NHS Constitution may help public awareness, noted Edwards. However, he cautioned that it fails to take account of the fact NICE tends to examine high-cost medicines, which can mean, he told the Committee, which may be very much less cost-effective than treatments which are already in use but have not been examined by NICE. “Withdrawing funding from these more cost-effective areas is not a good use of resources,” he said.

The role of NICE is to give the NHS certainty, based on an examination of the evidence base, and this is a role best undertaken centrally rather than in each PCT, added David Pruce, Director of Policy and Communications at the Royal Pharmaceutical Society of Great Britain. “NICE should attempt to do this at as early a stage in the life of a medicine as possible, so that patients are not denied important innovations,” he said.

Speeding up the process will mean that, if NICE does decline to recommend a drug, patients can then at least work out what they can then do to see if they can fund it; “the worst thing is having patients in limbo,” added Pruce. He also hoped that more risk-sharing schemes for high-cost drugs will be agreed with manufacturers, such as that for Janssen-Cilag’s Velcade (bortezomib). These are good for the NHS and suggest that drugmakers have faith in the products, he told the MPs.