Sir Ara Darzi has this morning unveiled a sneak preview of his vision for the National Health Service, stressing a greater emphasis on change that is driven locally, not centrally, and the importance of innovation to progress.

The ultimate goal, he says, is to develop the NHS into a “universally world-class” Service that delivers effective, safe, higher-quality services “personalised to individual needs, and equally available to all”.

A key aspect of how to bring about this change is to give local NHS staff more influence in making local decisions based on the best available evidence and responding to patient needs. “This is not about imposing more change from the centre,” Sir Ara said. “Effective change needs to be brought about locally, driven by clinicians and others working in partnership across the NHS.”

This point echoes the findings of a report released yesterday by the NHS Confederation and the Joint Medical Consultative Council, which advocates the closer involvement of clinicians in making local decisions.

“There is clearly great potential in getting clinicians to help to create a better, more efficient health service that is able to innovate and fully meet the needs of patients,” commented NHS Confederation director of policy, and co-author of the report, Nigel Edwards. And Bill Dunlop, chair of the Joint Consultative Medical Council and co-author of the report, added: "Our report found that many doctors have themselves initiated change and developed innovative solutions locally. Clinicians want to work in partnership with their NHS trust managers to design better services for patients and to be freed from the policy constraints which so often interfere with their desire to innovate and improve patient care.”

The British Medical Association has also voiced its support for the move. “We are particularly pleased that Lord Darzi does not want to impose change from the centre and we agree that effective change needs to be led locally and driven by clinicians, and others, working in partnership,” said Dr Laurence Buckman, Chairman of the BMA’s GPs committee, while Dr Jonathan Fielden, Chairman of the BMA’s Consultants Committee, agreed: “Consultants as leaders and innovators in healthcare delivery will welcome the change of focus towards high quality patient-centred care.”

“However”, he stressed, “it is vital that this change in language at the centre translates into practical freedom for clinicians on the ground, so they can work with patients to make the NHS a truly world class service.”

Immediate actions for progress

Sir Ara has laid out some immediate steps that should be taken prior to the release of his final report next year, to help move beyond the mere expansion of the Service and focus on delivering real benefits to patients as quickly as possible.

Central to this, he claims, is an injection of new resources into primary care in areas with the poorest provision. Furthermore, a batch of new health centres, or polyclinics, in easily-accessible locations should offer a whole host of convenient services to patients, and primary care trusts must bring in new measures to help expand GP surgeries’ opening hours. “Our aim is that, over time, the majority of GP Practices will offer patients a much greater choice of when to see a GP, extending hours in to the evenings or weekend.”

The NHS Alliance agrees that “enabling GP practices to open for longer hours or on Saturday mornings will help patients in many areas”, and “investing in new GP services for under-doctored inner city areas will make it possible those who are not presently registered with a GP to access a local surgery.”

But, it warns, “none of these must be allowed to become tick box exercises. In the past, an over-simplified approach has meant that national targets have been met without making a positive difference to patient care. That must not be repeated.”

Innovation crucial to better patient care

Another key aspect of Sir Ara’s interim report is the importance of innovation to progress and, to this end, he has announced the establishment of a new Health Innovation Council. Chaired by Sir Ara and backed by a fund of up to £100 million, it will be the Council’s duty to help the NHS develop and use hi-tech healthcare.

“I want to see the UK become a world-leader in pharmaceutical and medical research and medical technology research and development, so patient have access to the best innovative treatments and services,” he explained.

Again, the move was welcomed by the BMA, which said it “believes that research for patient benefit underpins the delivery of high standard healthcare,” and that “additional funding for innovation, particularly in diagnostics, will not only benefit patients but will also help train academic staff and tomorrow’s doctors.”

A new constitution?

In a fairly radical but not wholly unexpected turn, Sir Ara has also addressed misgivings over the degree of political control over the Service, concluding that the NHS “could benefit from greater distance from the day-to-day thrust of the political process.”

Consequently, NHS Chief Executive David Nicholson has been tasked with chairing a national working group of experts to assess the potential introduction of an NHS Constitution.

And, in response to growing concern over the battle against hospital-acquired infections, Sir Ara has called for the introduction of MRSA screening for all elective admissions next year, with an extension to all emergency admissions within the next three years, a move that should prove very popular with the voting public.

His full vision for a world-class NHS will be published in June 2008, just before the Service celebrates its 60th birthday.