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Darzi sets out new rules for polyclinics
Five pledges will ensure that change is transparent and driven by the best evidence.
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.
These are embodied in 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 Existing services will not be withdrawn until new and better services are available to patients so they can see the difference.
Leading Local Change, published today can be found at 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.
They are:-
(i) Driven by clinical need.The 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, the 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.This will be 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 has been 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 Scrutiny Committee may review and scrutinise the proposal. 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.
Posted 9 May 2008