Action on the ground is proving as fascinating as Westminster tussles
There are two narratives running in parallel on the current NHS reforms. Within Whitehall and Westminster and among the health policy chattering classes debate rages over the exact intention of each clause of the Health Bill.
Number 10 advisers struggle with how to “detoxify” the reforms and are finding that tugging at one string threatens to unravel the whole patchwork. The changes signposted as arriving after Easter are likely to be more about pace and presentation than any kind of U-turn.
Out in the real world, the NHS is shaping itself to the new reality driven much more by well established local behaviours and pressures, with an increasing dash of central direction, rather than any allegiance to health secretary Andrew Lansley’s vision.
Dame Barbara Hakin, the managing director for commissioning development, makes it clear that she expects the new “system” to prevent any harmful consequences of the reforms - intended or unintended. It is increasingly clear that this system will be firmly governed by the new NHS Commissioning Board.
What is perhaps surprising is how widely welcomed this is. A senior GP leader told HSJ last week: “I trust [board chief executive-elect] David Nicholson implicitly”, expressing the view that his “belief in the NHS” would see the reforms implemented in a way that did not undermine its traditional values.
Our survey indicates the great majority of GPs and primary care trust staff think consortia will have taken on “material responsibility” for commissioning within 12 months.
This makes what is happening on the ground just as interesting as what is happening at the centre. For example, exclusive analysis by HSJ has revealed that while consortia are mostly forming along predicted lines, a number of well performing practices are banding together to the exclusion of less successful neighbours.
An early test, perhaps, for the wisdom and practicality of “system intervention”.
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Readers' comments (4)
Calum Paton | 4-Apr-2011 7:59 pm
On April 5th, the House of Commons Select Committee on Health publishes its report on 'Commissioning - Further Issues.'
One of the key issues which the Committee has examined is whether, if the Health Bill is passed, it is allowable to commission integrated services or 'designated' packages of care, in the public interest. That is, if so, such an interest would override the 'pro-competitive' requirement that each element of such a package must be tendered for competitively.
It is becoming clear that Ministers (under political pressure to eschew the dogma ofthe market) accept that certain types of integrated provision are acceptable. Andrew Lansley told the Committee that he agreed with the Chair of Monitor's interpretation to this effect - with Monitor also having had to row back from its initial neo-liberal predilections.
But this leaves three related but different questions unanswered.
(1) Will secondary providers (eg hospital doctors) be allowed to collaborate in commissioning specifications without prejudicing their hospital's ability to tender, or participate in an integrated tender? If not, the exhortation to collaborative commissioning will be worthless.
(2) Will separate provider Trusts be able to collaborate without falling foul of 'competitive' regulation (Monitor/OFT/CC.)? If not, there will either be inappropriate competition or an impetus to inappropriate mergers (ie private monopolies, much worse than state providers acting together.)
(3)Will integrated provision be subject to competition ie an integrated provider can only get a contract ifthere has been a competitive tender? If so, the cost will be ver high.
The Committee has done a good service. But much more reassurance is required.
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Anonymous | 5-Apr-2011 12:39 pm
"(2) Will separate provider Trusts be able to collaborate without falling foul of 'competitive' regulation (Monitor/OFT/CC.)? If not, there will either be inappropriate competition or an impetus to inappropriate mergers (ie private monopolies, much worse than state providers acting together.)"
And if they can, they'll risk cartel allegations from Europe (because this is precisely what they'd be).
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Calum Paton | 29-May-2011 12:40 pm
I think the last commentator has forgotten the politics.....it may well be that mergers are allowed by Janus-faced Ministers exactly as a means of avoiding nylon-underpanted competition wonks in Europe or elsewhere........!
Now, mergers may be fine.....but less likely if created for perverse reaons ie getting round summat which need not be there in the first place!
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Calum Paton | 29-May-2011 12:41 pm
should've added - a cartel is different organizations illegitimately colluding.....not one organization!
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