'Lansley may play down his reforms' radicalism, but this does not involve big changes to his plans'
“Some have argued Liberating the NHS constitutes an unwise distraction from the quality and productivity challenge facing the NHS.
On the contrary, the reforms will support [it].” So declares the government’s response to the white paper consultation.
It continues: “some argue the Government’s reforms will fragment the NHS. The reverse is true… our plans reinforce the fact that the NHS is an integrated system.”
It also rejects myriad suggestions to slow the reforms, stating: “The Government’s intention is to undertake structural reform rapidly.”
While health secretary Andrew Lansley may play down his reforms’ radicalism, this clearly does not involve big changes to his plans.
The most significant measures appear to have been introduced in the 2011-12 operating framework. Key messages include extending the deadline for efficiency savings to March 2015, introducing competition on price in the next financial year and forcing primary care trusts into 50-odd “clusters” to aid transition.
If the bad news for PCTs arrived this year, 2011-12 looks likely to be very difficult for providers, with the Department of Health taking a hard line on cutting tariffs. For many, next year looks like a choice between a pay freeze or redundancy.
The consultation response is adamant commissioning consortia will not “recreate” PCTs. But our analysis of the 52 pathfinders suggests a close - if not exact - match in size. The response confirms a consortium’s accountable officer need not be a clinician.
Anecdotal evidence too suggests an evolutionary process on the ground. HSJ spoke to a former PCT chief executive now running a pathfinder. He was looking forward to moving his new organisation into the former PCT offices.
HSJ wishes all its subscribers a happy Christmas and, particularly for those facing an uncertain future, a good new year.
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Readers' comments (5)
Patrick Newman | 15-Dec-2010 4:55 pm
This is not a million miles from where PCT's started in 1998 and when it was said we would have a primary care lead NHS and PCT's would be close to communities often co-terminus with local council boundaries. Plus ça change, plus c'est la même chose. Furthermore it is inevitable that the costs of change will be greatly underestimated. Was it not possible to adapt, collectivise and extend PBC.
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Neil Jessop | 16-Dec-2010 8:01 am
More like PCGs rather than PCTs!
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Clive Peedell | 19-Dec-2010 5:41 pm
I would like to hear what the NHS Confederation thinks about the significant move towards price competition. This was their thinking in their initial response to the White Paper:
"Price competition is the standard tool in free markets for driving down costs and increasing efficiency. However, economic theory and evidence show that it has particular risks in healthcare markets. Economic theory predicts that price competition is likely to lead to declining quality, where (as in healthcare) quality is harder to observe than price. Evidence from price competition in the 1990s internal market and in cost-constrained markets in the US confirms this, with falling prices and reduced quality, particularly in harder-to-observe measures".
http://www.nhsconfed.org/Documents/Response%20to%20Regulating%20healthcare%20providers%20FINAL.pdf
I wonder if Nigel Edwards is happy with Lansley's move away from the "quasi-market" to a much more open healthcare market. I think 95% of NHS stakeholders deserve to know.
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Anonymous | 24-Dec-2010 0:17 am
Good question Clive. The confed are generally right but they have lost their way lately. Nigel backing Nicholson was a mistake. Not because of Nicholson's reputation but on point of principle the confed ought to be representing members and not picking sides. Since DH now fund so much of the Group this has messed with any sense of objectivity and integrity. It should remain and honest broker. Lots of companies like confed and HSJ will have a shrinking client base and will need a radical new business model. Being independent and objective is going to continue to prove challenging, especially if DH are the paymasters.
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Anonymous | 31-Dec-2010 11:19 am
Can anybody explain the sense in having clusters of PCTs which are NOT coterminous with local authority boundaries, which is what is proposed in some areas?
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