F orget Gordon Brown, or even Alan Johnson, the Health Secretary. It is Lord Darzi of Denham, the junior health minister, who has the most power and influence in today’s health service.

That is, according to the Health Service Journal, which noted the impact that the surgeon’s landmark Next Stage Review has had on the NHS.

The year-long project, which was reported to have considered the views of 60,000 people and 2,000 health-care staff, was “a big challenge”, he said. “I was euphoric in July when it was published, because it was largely well received by the people who matter – clinicians and patients. But once I’d got over that, I realised that the implementation would be more of a challenge than the review itself.”

Although couched in buzzwords and Department of Health jargon, the review boils down to three “nonnegotiable parameters” – safety, effectiveness and patient experience. Since the review an NHS Constitution has been published, local “polyclinics” set up to improve access to GPs and there has been a focus on measuring quality.

Although some doctors regard his political role with suspicion, Lord Darzi is a big fan of engagement and toured the country to discuss his ideas with medical colleagues. “It’s not a bunch of pointy heads sitting in the Department of Health, dreaming up these ideas, they are produced in partnership with people working on the ground,” he said.

He still sees patients and conducts research at St Mary’s Hospital, London, two days a week, but does he enjoy being a minister? “I don’t do power,” he said, adding that he prefers a plain black case to his official red box. “I enjoy making a contribution. I don’t wake up in the morning and say ‘I’m a minister’ . . . I’m still a surgeon at heart.”

The NHS has been “chasing its tail” in recent decades, simply reacting to demands, he said. But after years of national targets, now with financial penalties for failure, it is up to local trusts to assess their priorities and spend their money effectively.

He suggested that the NHS is in “good shape”, with enough money going into the system to counter the public health challenges of obesity and an ageing poplation. “A few people were critical that there wasn’t a chapter at the end [of the review] telling them exactly what to do but I want an NHS that is proactive.”

He also gives short shrift to critics who say that as a surgeon he does not understand local health services and that a national roll-out of walk-in clinics was unnecessary. “I make no apologies for increasing investment in primary care,” he said. “There wasn’t any plot behind this, we’ve never said ‘one size fits all’, we only wanted to improve access. In some areas it’s been successful, in others it hasn’t.”

Where financial incentives fail to produce improvements, he hopes that feedback, patient-reported outcome measures or new “quality accounts” for every trust will succeed. Lord Darzi claims the NHS should focus on providing an “experience” rather than a basic level of care.

“While any café can serve a cup of coffee, Starbucks sells you an experience,” he said. “The taxpayer needs to be sure that we can meet core standards – on healthcare-associated infections or waiting times – but I am talking above and beyond that. If hospital X and hospital Y can both offer hip replacements within 18 weeks, we need to talk about what is the difference in experience in these places before [a patient] exercises their choice.”

As well as rigorous efforts to reduce MRSA infections or safety errors, quality should also include the little things, whether patients were treated with dignity, can walk properly after an operation or would recommend a doctor or hospital to their friends.

He thinks patients will want to give feedback and that doctors will want to listen and improve. “Never underestimate the competitive nature of clinicians,” he added.

The lowdown

Who
Professor Lord Darzi, 49, is Parliamentary UnderSecretary of State for Health and Chair of Surgery, Imperial College London.

When
Born in Iraq, Ara Darzi trained as a doctor in Ireland before moving to the UK in 1990 to become a consultant surgeon at Central Middlesex Hospital, later joining Imperial College where he pioneered keyhole surgery. Knighted in 2002, he was appointed a minister and made a peer by Gordon Brown in 2007, and asked to lead a large-scale review of the NHS in England.

What
Published in July, the review promised “High-Quality Care for All” much of which will be implemented in the Health Bill. Plans include an NHS Constitution, personal budgets for those with chronic conditions and greater weight for patient feedback.

Why
“I feel like I make a difference when I’m treating patients one-to-one, but I came to realise some years ago that with policy, you can have a much bigger impact,” he says.

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