Niall Dickson: Well-informed patients will make better decisions

'The biggest test, as ever, will be translating the vision into reality'

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If good intentions were enough to cure the 60-year-old NHS of its problems, then the job would be well and truly done.

Sadly, when it comes to the health service, it is the gap between policy ambition and the reality of implementation where so many come unstuck. It probably does not help when the Prime Minister and the Health Secretary bill your report as a once-in-a-generation opportunity.

Of course, it was always going to be difficult – no amount of government hyperbole can detract from what is essentially a continuation of Blairite reforms. But that does not make it a bad thing – this review could help to transform healthcare services in ways that traditional reorganisations have repeatedly failed to do. The big test, as ever, will be translating the vision into reality.

Indeed, one of its greatest attributes is what it does not do – there is no big organisational shake-up and no dramatic changes in direction. The report presents a sensible set of measures designed to improve the quality of care, while sending out a clear signal that responsibility for shaping and leading services lies with staff at a local level.

For the first time in a systematic way, services throughout the NHS will be judged and paid for on the basis of the outcomes they achieve. Quality measures will become more important – the old traditional process targets, such as the 18-week wait for treatment, survive but are relegated to being minimum standards.

This should help us all make more informed choices and encourage those providing the care to do better.

On the downside, there are two omissions – first there are no estimates of how much all this will cost; second, there is no indication of just how different the Government expects the health service to be in five or 10 years' time.

Some of the answers lie in the regional plans that have been developed by the strategic health authorities, but an overall view of how far and how fast the Government expects the NHS to change would be helpful. The regional plans also highlight a real tension – the Government is in favour of encouraging local decisions, yet the Health Secretary is keen that patients in one area should not be disadvantaged when compared to another. He wants a universal service, but not a uniform one.

A similar tension is apparent in the NHS constitution and the promise to end the postcode lottery with a right for every patient who needs them to have access to drugs approved by the National Institute for Clinical Excellence (Nice). But some decisions about drugs will still be made locally for drugs that have not yet been Nice approved, and for those patients living in areas where they decide not to fund, the lottery will seem alive and well.

But these should not detract from the main message – which is that as patients we not only want a larger, quicker health service, we also want a better one. A service where our patients are not at risk from MRSA and where GPs refer to specialists at the right time. We want a service where staff are kind and don't lose our notes, and don't keep asking the same questions. Where we get fed when we are hungry and given the pain relief when we need it.

That is what is meant by quality of care and today's report puts that centre stage.

Niall Dickson is chief executive of the King's Fund

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