Patients' happiness with their treatment will be used to set hospital budgets under a radical shake-up of the NHS annouced yesterday.

Satisfaction levels will determine funding while 'fines' will be levied on trusts which make mistakes.

Payments will be based on factors such as the levels of pain endured by patients, the cleanliness of toilets and even how often the staff smile.

Reforms: Gordon Brown speaks with Health Minister Lord Darzi at Leatherhead Community Hospital yesterday

For an average-sized district general hospital it could affect £7million to £9million of an annual £250 million budget  -  about 4 per cent of the total.

The long-awaited review of the NHS was unveiled ahead of its 60th anniversary on Thursday.

It aims to make high-quality care the Health Service's main priority for the next ten years.

In what is described as a world first, a constitution will provide patients with a legal right to choose their GP practice and preferred hospital doctor, although it is unclear how this will work in practice.

Hospital boards will also have to produce annual quality of care 'accounts' to ensure it stays top of the agenda, according to Lord Darzi, the health minister in charge of the review.

He said: 'For the first time, patients' own assessments of the success of their treatment and the quality of their experiences will have a direct impact on the way hospitals are funded.'

Many of the 'ambitious plans' put forward have been publicised in recent months, including vascular health checks for middle-aged people, person-alised care plans and pilot schemes for personal health budgets.

Although most of the rights in the draft constitution already exist in practice, they have been brought together to clarify what patients can expect from the Health Service.

Sweeping changes: The Government's plans will see hospitals' who fail to satisfy their patients have their incomes slashed

Among these is a strengthened legal right for patients to receive all drugs and treatments approved by the National Institute for Health and Clinical Excellence, in a bid to end the current 'postcode lottery'.

The rationing body's approval process will also be speeded up so drugs can be approved for NHS use within six months, a system already operating for cancer drugs.

But the changes will not address the problem of 'NICE blight' when trusts refuse to fund drugs prior to approval, or lack of access to drugs deemed too expensive for the NHS.

Health Secretary Alan Johnson said he wanted to avoid a 'lawyer's charter' in the constitution and that patients must still recognise their responsibilities to the NHS, such as keeping appointments.

The Government will be legally obliged to renew the constitution every ten years.

Mr Johnson said: 'I think it strikes the right balance between the need for clarity and avoiding undue litigation, between the need to state what is enduring while ensuring the NHS his the flexibility to change and keep pace with rising expectations and medical advances.'

Lord Darzi's review says the key to improving quality will be publishing data online so patients can make judgments about where to go.

But critics last night said the review would increase bureaucracy and control from Whitehall, despite the Government's claims that it gives responsibility to staff at local level.

Tory health spokesman Andrew Lansley said: 'The complete lack of vision in these proposals means that, sadly, the Government has missed its "oncein-a-generation opportunity" to enact the real reform that our NHS needs.

'Instead of scrapping the targets which distract doctors from delivering the best possible health care, Labour have opted for more of the same.'

LibDem health spokesman Norman Lamb said: 'When the dust settles people will see that little has changed and that the system of command and control diktat by Whitehall lives on.'

The independent King's Fund said there were significant omissions and no estimates of how much the plans will cost.

Chief economist Professor John Appleby said the changes at NICE did not address a 'main area of dispute' when some trusts are reluctant to fund licensed drugs before evaluation for NHS use.

Katherine Murphy, of the Patients' Association, said: 'Patients have waited too long for these changes. The postcode lottery is the opposite of what the NHS should be about.'

Dr Hamish Meldrum, chairman of the British Medical Association council, said 'There is much here that could bring about improvement  -  if it can be delivered.'

KNOW YOUR RIGHTS

• You have the right to be treated with dignity and respect.
  

• You have the right to access your own health records.
  

• You have the right to make choices about your NHS care.
  

• You have the right to choose your GP practice and to be accepted by that practice unless that are reasonable grounds to refuse, in which case you will be informed of those reasons.
  

• You have the right to express a preference for using a particular doctor within your GP practice, and for the practice to try to comply.
  

• You have the right to seek treatment elsewhere in Europe if you are entitled to NHS treatment but you face undue delay in receiving that treatment.
  

• You have the right to drugs and treatments recommended by NICE (the National Institute for Health and Clinical Excellence) if your doctor says they are clinically appropriate.
  

• You should treat NHS staff and other patients with respect and recognise that causing a nuisance or disturbance on NHS premises could result in prosecution.
  

• You should keep appointments or cancel them in reasonable time. Receiving treatment within the maximum waiting times may be compromised unless you do.
  

• You have the right to compensation where you have been harmed by negligent treatment.

FACE IN THE NEWS

LORD DARZI

Health minister Lord Darzi's plans to transform the NHS have not been welcomed by doctors

He insists that he is first and foremost a doctor.

Indeed, within five months of taking up his Cabinet post, Lord Darzi was on his knees in the House of Lords saving the life of a fellow Labour peer.

Lord Brennan had a heart attack during a debate last November.

Lord Darzi (pictured) leapt over the benches and administered mouth to mouth, a heart massage and electric shock treatment using a defibrillator.

But saving lives is what 48-year-old Ara Darzi is used to - not piloting bills through Parliament.

He was born in 1960 in Baghdad, after his Armenian parents fled to Iraq during the First World War to escape the genocide by Turkey.

He was brought up in the Russian Orthodox faith of his family, although he went to a strict Jewish school.

Aged 17, Darzimoved with his family to Dublin to study medicine, later becoming a surgeon and earning the nickname 'Robodoc'.

A keen Pink Floyd fan, he became a UK citizien in 2003, a year after being knighted.

Despite being appointed Health Minister by Gordon Brown in June 2007, he still performs surgery on Friday and Saturdays and the transition from doctor to minister has not always been smooth.

He has landed his boss in trouble several times, for instance by admitting Labour's pledge to end mixed-sex wards 'cannot be met'.

And he embarrassed collegues by announcing pharmacists would be able to hand out the Pill to under 16s without a prescription.

Protests can't stop the super-surgeries

Ministers are to press ahead with super-surgeries  -  even though more than a million patients have signed petitions against the plans.

Despite fierce objection to the so-called ' polyclinics' only two paragraphs mention them in yesterday's report.

It does say that there is no 'national blueprint' for the polyclinics, and it will be up to local health chiefs to decide where they should be placed.

However, there will still be 150 in London and 121 in the rest of England.

Labour is pushing the polyclinics idea because patients have said they do not like trailing to hospital-for a simple blood test or an X-ray.

The clinics are designed provide more healthcare closer to patients' homes.

Access to doctors is another reason ministers are keen to push the idea.

Working people have found it harder to see GPs since they were allowed to opt out of evenings and weekends in 2004.

Many of the polyclinics will be open from eight in the morning to eight at night, seven days a week.

But the initiative has been condemned by GPs who fear it will force local surgeries to close.

Some patients  -  mainly the elderly  -  fear services will be centralised in the polyclinics, forcing them to walk further to their GP.

Shopping around for the best care

The individual budgets proposed in the report are part of Labour's efforts to increase choice in the NHS.

The plan, being piloted among 5,000 patients, will allow those with chronic conditions including MS, motor neurone disease and severe forms of asthma and diabetes to spend funds worth thousands of pounds.

They will also be able to shop around for care and swop one treatment for another - although they will not be able to use private health services.

Patients will not be given money directly. Instead they will be allocated a set amount of 'virtual' funding to buy the treatment they want.

But doctors oppose the plans - saying they could force wards to close.

Hospitals are funded according to how many patients they treat, meaning under-used services could be axed.

The British Medical Association also warns that because departments cross-subsidise each other, the failure of one to attract patients could affect another.

The report also announced that 15million patients with long-term conditions would receive a personal care plan.