Response to NHS next stage review

The NHS Next Stage Review (1) is a step in the right direction for the NHS – but important details are lacking, says the Nuffield Trust today.

Nuffield Trust Chief Executive Dr Jennifer Dixon said: “The vision of devolving more power to the front line, no top down reorganisation and empowering patients is the right one. The key thread throughout is increasing the focus on quality of care. But while pilots to promote integrated care are particularly welcome, the report is much longer on the ‘what’ than on the ‘how’.

“Faith is largely put into the public reporting of clinical outcome indicators of quality, along with minimum standards (which replace top down targets), as well as introducing a quality adjusted payment by results tariff for organisations providing healthcare and stronger powers to enforce safety by regulators. This mix is likely to help to refocus efforts on quality ‐ and should be evaluated ‐ but important elements are missing. “First, the report is vague on how GPs might be incentivised to take part in practice based commissioning. Commissioning is the lynchpin to help improve the quality of care. Engaging doctors and other clinicians meaningfully is critical to successful commissioning. “Second, a national group coordinating the overall strategy for quality is a good idea, one championed in the recent Nuffield Trust report Quest for Quality '(2). But the relationship between the new National Quality Board and the emerging health and social care quality regulator (the Care Quality Commission ‐ CQC) is opaque in places. (2)

“For example the National Quality Board and CQC both appear to be reporting annually to Parliament on the state of health. Furthermore the National Quality Board is to be chaired by the Chief Executive of the NHS, and therefore not independent. It is also unclear how the new quality observatory to be set up in each region will relate to the activities of the new CQC. This suggests that the role of performance management relative to regulation in improving quality is insufficiently defined.

“Third while patient choice of provider is continued as a lever to improve care, as it has been since 2000, there is no mention of the place of competition between the NHS and non‐ NHS providers for mainstream services to provide challenge to NHS organisations to improve performance. “Many policy documents like the Next Stage Review have admirable aspxirations,” said Dr Dixon, “but to get noticeable action, there needs to be much closer attention to incentives if we are to unlock ‘the creativity and ambition of public sector workers to innovate and drive up standards in partnership with service users’, as today’s other policy document from the Cabinet Office (3) put it.”