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Lord Darzi’s interim report, Our NHS Our Future , also appears to reach similar conclusions. Indeed, the terms of reference clearly stated the review should build on the reforms already underway. Lord Darzi supports this position and writes that his aim is "to convince and inspire everyone working in the NHS, and in partner organisations, to embrace and lead change." He believes that there is "a chance to shape the future of the NHS in a new way", and that the ultimate goal should be to create a "world class" health service that is "developed and owned by patients, staff and public together."
Lord Darzi identifies four core principles which he believes should underpin the health service: a fair service, a personalised service, an effective service and a safe service. He then examines each one in detail. Interestingly, he sees an increased role for the independent and voluntary sectors in primary care, both in bringing "dramatic improvements" for patients and challenging existing ways of working among healthcare organisations. However, he also shares the view that local decision making should replace national procurement.
The evidence clearly suggests that the Government remains committed to using the independent sector to provide NHS services as a general principle. This point has been made repeatedly by ministers – most notably by the Prime Minister in his speech to the CBI annual conference in November and again in January. However, the Government is also learning from its early experiences and is reviewing when and where private providers are likely to be most effective.
The emphasis is also moving towards creating frameworks within which local organisations can commission local services to meet local needs, rather than a national solution being imposed from the centre. The DH is giving particular attention to primary care services – which is unsurprising given its wider objective to move treatment from secondary to primary settings wherever possible. The idea of encouraging more decision making at the front line is also being encouraged in many other areas. However, allowing local organisations to make up their own minds may mean that new ways of working are not adopted as quickly as the DH would like. This conflict has never been satisfactorily resolved – though one possible solution would be for it to offer incentives to local bodies to encourage change.
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