Last month saw the long-awaited arrival of the NHS Next Stage Review, otherwise known as the Darzi Review after its author, leading surgeon and health minister Lord Ara Darzi.
Billed as a ‘once in a generation’ review of the health service, the process entailed extensive engagement with clinicians and the public and with a variety of stakeholders. This resulted in the publication of specific plans for strategic health authorities, each of which were very much the product of that particular region with a strong sense of their ownership.
In addition, the government published the overall national review, High Quality Care for All, a separate report on health service staff, A High Quality Workforce, a new vision for primary and community care, and a draft NHS constitution for consultation. All in all, a considerable output.
The whole emphasis of the Next Stage Review is ensuring the NHS concentrates on improving quality – and that creates an exciting and challenging agenda. There is a welcome recognition that workforce issues are central to delivering the quality agenda. From NHS Employers’ perspective, it is excellent that workforce issues, and particularly the importance of engaging and involving staff, are themes running through all the reports.
Many of the proposals on workforce had been signalled and built on existing policy initiatives. We welcomed thinking around the face of the future NHS workforce and tomorrow’s clinicians, including the different aspects of the clinicians role as practitioner, partner and leader, making nursing an all-graduate profession (something we supported in the recent Nursing and Midwifery Council consultation), the modernisation of scientific careers, and the extension of regulation to support staff. An increase in the number of apprenticeships available is also a positive step, but as with all such developments, particularly ones that involve such a wide range of stakeholders, it is crucial that their development and implementation are well-managed over a sensible timescale.
Throughout the process, NHS organisations have been promoting an employer-led model of workforce planning and education commissioning. It is important that provider employers should be in the driving seat as far as workforce planning is concerned. The report signals the importance of employer engagement in these processes but it is not clear how this will work. As is recognised, there is still a lot to do to develop the detail of an effective system in this area.
The primary and community care strategy strongly encourages the development of social enterprise organisations led by existing staff to provide some existing primary care trust services. The proposal to allow staff transferring to those social enterprises to remain in the NHS Pension scheme is to be welcomed, as it will smooth the progress of transfers and prove reassuring to staff. There is no detail yet on how this will work, but it would be important that arrangements do not inadvertently set up any new barriers to change.
As has been widely reported, the Darzi Review praises those foundation trusts who have shared proceeds of their success with their employees, and recommends that such schemes should be more widely adopted. There are also proposals for organisations to be financially remunerated for certain improvements in patient experience and quality of services.
Importantly, the draft NHS Constitution has a specific section on staff rights, pledges and responsibilities. The new pledges on the need for staff to have rewarding jobs, personal development, a healthy and secure environment and involvement in decision making reflect good employment practice. It makes sense that everyone providing services for patients should be working towards the same purpose and vision.
We welcome many of the proposals that have emerged from the Darzi Review, which seek a fit-for-purpose workforce delivering high-quality patient care. We will now want to work with the Department of Health, local organisations and staff partners to ensure we can translate all the ideas into real and sustainable improvements.