High Quality Care For All
The NHS "once in a generation" review by Lord Darzi: High Quality Care For All is now published.  
A downloadable copy of the review is availalbe from the OurNHS website here.

Key points 
(drawn from reading the documents, the Kings Fund analysis and the NHS Alliance press releases).

• It has been well received by most health bodies who agree with the principles and vision but question how it will be implemented.  There is no major structural change proposed. There are no new targets. The focus in on improving quality.
• The plan is to decentralise power to SHA level, to acknowledge regional variation.  There are questions about whether it will stop there, or whether it will be pushed down further to PCT and PbC levels.  Local accountability must accompany the shift in power.
• The plan is not costed.
• It lays out the vision of a service that is
  • Tax-funded
  • Free at point of need
  • Offers patients more information and more choice
  • Works in partnership
  • Promotes equality (and reduces variation)
  • Helps people stay healthy
  • Has quality of care at its heart
    • Clinically effective
    • Personal
    • Safe
• The centrepiece is described as the visions of each region, provided by clinicians and other healtlh and social care professionals.  There is a strong focus on local clinical leadership, which IMPRESS also advocates.
• The first priority is to reduce variation in quality of care whilst responding to individual patient need and local differences.
• There's a  new emphasis on public health and disease prevention. Several new measures will be introduced to help people stay healthy:
  • Every PCT will commssion comprehensive wellbeing and prevention services, in partnership with local authorites, with the services offered personalised to meet the specific needs of their local  populations. There are 6 key goals:
    • tackling obesity
    • reducing alcohol harm
    • treating drug addiction
    • reducing smoking rates
    • improving sexual health
    • improving  mental health
  • A Coalition for Better Health  focused initially on obesity  between Government, private and third sector.
  • Roll out of Reduce Your Risk campaign - vascular risk only.
  • Introduction of Fit For Work services to support return to work
  • Improvements in QOF 
• In a more controversial proposal, patients will be offered more choice of GP practice and high performing practices will receive better rewards.
• Patients will be able to check on care providers using NHS Choices
• There will be an NHS Constitution, defining citizens' rights to choose. This has been positively received. The challenge will be to provide sufficient information.  It also enshrines staff rights.
• Everyone with a long term condition will have a personalised care plan.
• There will be pilots of personalised budgets. Commentators regard this as more challenging than personalised budgets in social care. 
• The NICE approval process will be speeded up, which is positive as long as the robustness of the process does not suffer. Patients will be guaranteed access to drugs and treatment approved by NICE.  Commentators suggest that this will not end variation because variation in access to services remains considerable, and not all licensed drugs and treatments, new and old, are assessed by NICE.
• There is a strong focus on leadership, including investment in clinical leadership that IMPRESS intends to consider over the next few months.
• Improving the quality of care will be supported by
  • New enforcement powers for Care Quality Commission
  • NICE will be expanded and a new National Quality Board will offer advice to Ministers on NICE priorities for clinical standard setting
  • NHS will be required by law to publish Quality Accounts
  • Staff will have access to a new NHS Evidence Service
  • There will be tariff changes and changes to the QOF
  • There will be a new Quality Observatory in every region
  • Innovation will be promoted through a new legal duty of SHAs
  • The horizon scanning process will be improved and there will be new partnerships between NHS, universities and industry
• There are pledges to support staff training and development including expansion of preceptorship, apprenticeship and accreditation schemes.

The Kings Fund commentary on the constitution summarises clearly the big shift: "The NHS constitution also reinforces the deal between taxpayers, patients and the state. It underlines the reality that the letters NHS no longer describe a state-run business – instead the NHS is a commissioner of comprehensive health care, free at the point of need. This means NHS care can be provided by all sorts of organisations public, private or from the voluntary sector."  Niall Dixon. 1 July 2008.