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Lord Darzi sets out tough rules for changes in the NHS

DEPARTMENT OF HEALTH News Release issued by The Government News Network on 9 May 2008

Five pledges will ensure that change is transparent and driven by the best evidence

Leading clinician and Health Minister Lord Darzi today issued five pledges to the public and staff on how the NHS will handle changes to services. He set out a rigorous process requiring any change to be transparent, clinically evidenced, locally led and for the benefit of patients.

Lord Darzi's report 'Leading Local Change' comes ahead of his final report on the next stage of NHS reform.

This new report, aimed at the public, patients and staff, signals that whilst the NHS must never back away from necessary change to improve services and save lives, there should be important checks which any change has to undergo before it proceeds. That is why today we are making five pledges on change in the NHS, which PCTs will have a duty to have regard to:

1. Change will always be to the benefit of patients. This means that change will improve the quality of care that patients receive - whether in terms of clinical outcomes, experiences, or safety.

2. Change will be clinically driven. We will ensure that change is to the benefit of patients by making sure that it is always led by clinicians and based on the best available clinical evidence.

3. All change will be locally-led. Meeting the challenge of being a universal service means the NHS must meet the different needs of everyone. Universal is not the same as uniform. Different places have different and changing needs - and local needs are best met by local solutions.

4. You will be involved. The local NHS will involve patients, carers, the public and other key partners. Those affected by proposed changes will have the chance to have their say and offer their contribution. NHS organisations will work openly and collaboratively.

5. You will see the difference first. Existing services will not be withdrawn until new and better services are available to patients so they can see the difference.

Lord Darzi said:

"The nature of healthcare means services will always need to change, and sometimes that means re-organising how services are provided.

"Our nationwide listening events have shown me that patients, the public and NHS staff are not opposed to change in principle but want to ensure it is done to save lives and improve quality and is not driven by cost or politics.

"This is not about change for change's sake. It's about change for the right reasons, improving quality of care for patients and saving lives. These pledges mean change will be locally-led, clinically-driven and evidence-based. And an independent high clinical bar for change should reassure local people everywhere that we mean what we say."

"The right way of doing this is to put local clinicians in the lead, with the public and relevant independent experts consulted and involved at an early stage. Ensuring that changes are based on the strongest clinical evidence and are relevant to their local communities. The role of national bodies has to be to support local clinicians with the best evidence.

"We are putting in place a process that ensures the local NHS rigorously checks proposals for change to ensure they meet the highest standards. The principles and guidance published today sets out how, where necessary, the NHS will make changes that will lead to real improvements for everyone - changes that are based on clinical evidence and supported locally by patients and the public.

"The focus of my report on the next stage of NHS reform will be how we can enable local clinicians and patients to be the driving force of improvement and change in the NHS. These proposals I am setting out today are only the first part of that. Empowered patients and empowered staff are the key to world-class standards".

The detailed operational guidance also published today, Changing for the Better, builds on the work set out in Sir Ian Carruthers review of service change and reconfiguration proposals published last year.

Since the start of the Review in July last year, Lord Darzi and his team across the country have been engaging widely with patients, the public and staff working in the NHS and other local organisations. Over 60,000 people have participated in the Review including nearly 2,000 frontline clinicians and other staff who worked as members of the clinical pathway groups.

Every area of the country will publish a clinicially led vision document over the next month, setting out priorities for improving health and healthcare over the next decade. Lord Darzi's final Review report will be published in June. It will focus on enabling and supporting the changes agreed locally by patients, the public and NHS staff.

NOTES TO EDITORS:

1. Leading Local Change, published today under embargo, can be found at http://www.ournhs.nhs.uk The document refers to eight key steps to deciding on substantive service changes to make the five pledges a reality. These eight steps are included in detailed operational guidance Changing for the Better also published today under embargo. They are:-

(i) Driven by clinical need Your local NHS will carry out a planning and needs assessment led by local clinicians. This will look at current services and how they fit with the latest developments in clinical practice and current and future needs of patients.

(ii) Early involvement in proposals. Based on the understanding of clinical needs, your local NHS will develop proposals for improving services, in conjunction with Local Authorities, the local third sector, local stakeholders and the public - ensuring that local people have the chance to have their say early on in the process, and that all proposals respond to their needs.

(iii) A high clinical bar for change. All proposals will be subject to independent clinical and management assessment. We will make this possible through the Office of Government Commerce's Gateway Review process. This is a process of peer review that identifies risks and issues at an early stage. This process will be supported by the National Clinical Advisory Team, whose membership will be drawn from members of the Clinical Working Groups. This means there will be a high clinical bar for change everywhere in the NHS, so that change is always to the benefit of patients.

(iv) Listening to you. There will be a formal period for everyone affected by a substantial change to have their say. Public consultation on the proposals for change will take place normally for a minimum of 12 weeks, although it may be possible to reach local agreement about a different timescale where appropriate. This will mean patients, the public and staff will be involved in the process.

(v) Responding to you. The local NHS will analyse what you have said, helping to inform, shape and strengthen local proposals for change.

(vi) Local decision. A decision on whether to go ahead with the proposed changes will be taken locally, based on the clinical and management case put forward, the benefits for patients and consultation responses. When the other steps are taken, we are confident that the local decisions will be the right ones for local people.

(vii) Making sure it's right. The Local Authority, through its Overview and Scrutiny Committee, may review and scrutinise the proposal. We believe that local issues need local solutions, so we are exploring options for the introduction of local mediation where multiple Overview and Scrutiny Committees in a Joint Overview and Scrutiny Committee cannot agree.

(viii) Appeal. The Overview and Scrutiny Committees will reserve the right to refer the decision to the Secretary of State for Health if they believe that the proposal is not in the interests of local health services. The Secretary of State may then ask for expert advice from the Independent Reconfiguration Panel, whose advice will be made public.

2. Lord Darzi's review was announced by Health Secretary Alan Johnson on 4 July 07 http://www.ournhs.nhs.uk/2007/07/04/alan-johnsons-announcement/

3. Lord Darzi's interim report was published on 4 October 07 and can be found at http://www.ournhs.nhs.uk/2007/10/04/lord-darzi-launches-his-interim-report/