The House of Commons Health Committee have the following produced report on the Darzi Review

• House of Commons Health Committee (2009) NHS Next Stage
  Review: First Report of Session 2008–09: Volume I Report, together with formal minutes. London: HMSO.
• House of Commons Health Committee (2009) NHS Next Stage
  Review: First Report of Session 2008–09: Volume II Oral and written evidence. London: HMSO.

Key conclusions and recommedations:

1. Significant involvement from SHA’s in review process was positive.
2. Emphasis on quality and leadership in the review requires implementation by Primary Care Trusts (PCT), there are doubts expressed about PCTs ability to undertake this,  particularly around planning and analytical skills.
3. Little evidence that World Class Commissioning will improve PCT commissioning skills.
4. Lack of clinical engagement with practice based commissioning that the review will not address.
5. Strategic Health Authorities have yet to effectively performance manage PCTs.
6. The priorities in the review are not ranked and it is unclear as to what are the most important.
7. There is little evidence of costing of implementation of the review and this is a matter of urgency.
8. Welcomes the reviews emphasis on the quality of care delivered.
9. Agrees with emphasis on measuring the quality of care but schemes such as Advancing Quality and PROMs which link the measurement of clinical process and patient outcomes must be piloted and evaluated rigorously before they are adopted by the wider NHS.  Key concerns are:
   1. Incentives should be part of the whole package not relied on to provide improvement.
   2. Incentives focussed on narrow areas of clinical improvement may lead to declining performance elswhere.
   3. Rigorous evaluation of the  Advancing Quality incintive scheme is required as it is designed for the USA and may not fit the NHS.
   4. Lack of information about how extensive the PROMs incentive
      scheme will be; how much it will cost to implement; when it will be fully
      implemented; and whether it will provide value for money
   5. The timetable for implementing the initial set of PROMs by April 2009 is
      challenging and lacks detail on how it will improve patient care or impact on the governance of clinicians.
10. The expansion in primary care supply needs careful management and evaluation to determine whether it leads to better evidence-based medical interventions for patients and whether it reduces disparities in health care access and utilisation between different social classes
11. £100 million has been provided for extra capacity in areas of need. The allocation of this money should be determined by national criteria measuring deprivation. PCTs and SHAs should be required to use these criteria and locate facilities where access and utilisation is poorest.
12. The Government has proposed that there should be a GP-led health centre in each PCT. While some PCTs, particularly those which are “under-doctored” or with a high burden of disease, would undoubtedly benefit from providing more primary care services it is less clear how other PCTs would benefit.
13. Neither the Government nor witnesses representing doctors could tell us what criteria should be used to decide whether a PCT needed a GP-led health centre.
14. While polyclinics and GP-led health centres can bring benefits they should be piloted to prove their value.  There is a risk that roll out will precede the results of the evaluation, which has the potential to waste taxpayers’ money and be grossly inefficient. The evidence that similar centres in Germany and the United States improve the quality of patient care and provide value for money is mixed.
15. GP-led health centres offer the potential for closer collaborative working between GPs, pharmacists and other clinicians. This should benefit patients by providing them with more integrated care. However, simply bringing health professionals under the same roof does not necessarily mean that they will work better or that they will start working together.
16. The GP-led health centres offer the potential for closer collaborative working between GPs, pharmacists and other clinicians. This should benefit patients by providing them with more integrated care. However, simply bringing health professionals under the same roof does not necessarily mean that they will work better or that they will start working together.
17. The committee heard a number of concerns about the Constitution, in particular, that it should not include too many legal rights; we note the NHS Chief Executive’s view that the constitution should not be a “lawyers’ charter”.
18. Recommends that the Department ensure that the Constitution gives sufficient emphasis to the responsibilities of patients and staff to the NHS.
19. There is a risk the NHS Charter will fail to engage the public in a meaningful way because people will view it as “a lot of waffle” without rights to care and treatment that are legally enforceable.
20. Welcome the establishment of a patient’s right to drugs and treatments that have been recommended by NICE for use in the NHS. However, it is important that it is recognised that the commitment will not by itself end the post code lottery which determines access to drugs and treatments not on the NICE approved list.
21. Welcomes the Department’s increased focus on improving its workforce planning in the NHS but raises concerns that SHAs should have a key role in this area.
22. Recognise the quality of leadership in the NHS must improve but raise the following concerns:
    1. Undue reliance on new institutions such as the Leadership Council; we note that previous attempts to improve the quality of management and leadership in the NHS by introducing new institutions such as the NHS University have failed;
    2. Department’s approach is over-centralised
    3. EEmphasis on medical leadership is important; however, we are concerned that at present many doctors are put off becoming senior managers. Recommend therefore that more training and support be given to those who wish to take on senior management responsibilities.
23. More emphasis on the importance of recruiting and developing better managers is required. Senior NHS management, clinical and non-clinical, should acquire analytical skills which will enable them to understand the products of expensive and increased investment in clinical and cost effectiveness data.  This should be a central component of their annual appraisals, and in the case of clinicians, linked to their systems of performance related pay.  Pay and promotion prospects of managers should be linked to their skills, in particular their ability to analyse and use data.
24. The National Training Programme has attracted graduates of great ability. They should be encouraged to take appropriate academic qualifications and be given sustained career support to ensure that their talent is exploited to the full throughout their careers.