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John lee

John lee

Recent activity

Comments (3)

  • Comment on: The Health Bill plan B is dead, but plan C lives on

    John lee's comment 18-Feb-2012 10:54 am

    In all the debate so far around the reform of the NHS, there appears to be an elephant in the room of whom nobody dares speak. It was alluded to recently in NHS Confederation Chief Executive Mike Farrar's call for an end to the "hospital-or-bust model of care”, with around 25% of hospital admissions capable of being avoided and patients cared for in their own homes or other community settings. He went on to suggest that this would involve "changing how health services are paid for –perverse incentives often mean it may not make financial sense to provide care out of hospital even though this may be best for patients". These perverse incentives are underwritten by the elephant in the room, Payment by Results. Introduced by the last Labour Government in 2004 to support the policy of Patient Choice, and let the money follow the patient, it has led to an unsustainable pursuit by providers of hospital activity, out-patient as well as in-patient pathways, whilst deflecting management attention away from managing the cost base. Furthermore, the Coalition’s focus on the growth in bureaucratic management structures in commissioning seems to miss the point that it has largely been symptomatic of the increasing complexity of the national tariff and HRG4, and that Clinical Commissioning Groups will require similar resources to those of the PCTs in order to performance manage under Payment by Results. Only a complete overhaul of current funding arrangements for hospitals will enable Mike Farrar’s exhortations to become reality, and ensure the continued premise of a health service free at he point of delivery.

  • Comment on: The Health Bill plan B is dead, but plan C lives on

    John lee's comment 16-Feb-2012 10:56 am

    In all the debate so far around the reform of the NHS, there appears to be an elephant in the room of whom nobody dares speak. It was alluded to recently in NHS Confederation Chief Executive Mike Farrar's call for an end to the "hospital-or-bust model of care”, with around 25% of hospital admissions capable of being avoided and patients cared for in their own homes or other community settings. He went on to suggest that this would involve "changing how health services are paid for –perverse incentives often mean it may not make financial sense to provide care out of hospital even though this may be best for patients". These perverse incentives are underwritten by the elephant in the room, Payment by Results. Introduced by the last Labour Government in 2004 to support the policy of Patient Choice, and let the money follow the patient, it has led to an unsustainable pursuit by providers of hospital activity, out-patient as well as in-patient pathways, whilst deflecting management attention away from managing the cost base. Furthermore, the Coalition’s focus on the growth in bureaucratic management structures in commissioning seems to miss the point that it has largely been symptomatic of the increasing complexity of the national tariff and HRG4, and that Clinical Commissioning Groups will require similar resources to those of the PCTs in order to performance manage under Payment by Results. Only a complete overhaul of current funding arrangements for hospitals will enable Mike Farrar’s exhortations to become reality, and ensure the continued premise of a health service free at he point of delivery.

  • Comment on: 'Only mugs work in commissioning’: tackling the management brain drain

    John lee's comment 6-Oct-2011 10:27 am

    The loss of commissioning expertise in PCTs, particularly in relation to PbR, the national tariff and the setting of local non-tariff prices, has already been comprehensively completed, as of the 30th June 2010. This was the date, 2 weeks prior to the publication of the White Paper, that an edict to shed all interim contracts in commissioning posts in PCTs was enacted. This has resulted in a dearth of talent and expertise within the staff "at risk pools", from which CCG commissioners are being appointed, and was the original reason from 2003 onwards why interims with predominantly finance backgrounds, were recuited. Prior to this, commissioning staff were largely drawn from clinical groups, some virtually innumerate. Now, with the pressure on CCGs to avoid large-scale redundancies, these same employees will be slotted into commissioning roles for which they are not suitably skilled, and hence Lansley's reforms will achieve nothing until PbR is dismantled, and Provider Trusts have an incentive to focus on their cost bases, rather than the continual push for extra activity and revenue!

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