20 questions the coalition must nail if its agenda is to succeed

The coalition has got off to an impressive start in rolling out its health policy. Speed and consistency have been to the fore. Judging from the feedback on HSJ’s website, the broad sweep of policy is seen as logical and appropriate to the challenges ahead.

If managerial numbers are to be cut by a third and private sector support restricted, how will the desired efficiency improvements be developed and delivered without distracting clinical staff from frontline responsibilities?

However, the detail that has emerged has inevitably given rise to some questions - many of them thorny.

Here are the 20 questions that HSJ believes the new government needs to address if it is to achieve its goals. Please post your own comments below.

1. If managerial numbers are to be cut by a third and private sector support restricted, how will the desired efficiency improvements be developed and delivered without distracting clinical staff from frontline responsibilities?

2. NHS spending has been protected, but can the government give assurances that it will not now become responsible for activities previously financed by other departments, or, especially, by cash-strapped local authorities?

3. If planned reconfigurations are to be reviewed wholesale for clinical credibility, how will the impact on finances in 2010 and 2011, caused by the delay, be mitigated?

4. What is the plan for non-NHS foundation trusts? How significant a role is the establishment of employee-owned trusts set to play?

5. Transforming Community Services and, especially, World Class Commissioning are consuming a huge amount of managers’ energy and time - should they be directing their energies elsewhere?

6. GP commissioners as gatekeepers to hospital reconfiguration? Please explain.

7. Will NHS staff and GPs be allowed to stand for election to PCT boards? What about councillors? If so, how will conflicts of interest be managed?

8. Will GP surgeries lose the right to refuse new patients, even if they are “full”? If not, how will the “right” to choose a GP practice be made meaningful?

9. Has the government abandoned its pledge to give patients the right to “choose” their own consultant?

10. How can the rating of individual doctors by patients be fair and meaningful?

11. What incentives - other than an increased role in commissioning - can the government offer GPs as part of a renegotiated contract? If the answer is “none”, why do they believe the GPs will want to revise the contract?

12. How and by whom will GP commissioners be held accountable? PCTs and/or the regional offices of the independent board?

13. Will PCTs provide the significant support needed as GPs build capacity and capability required to deliver effective commissioning? (see question 1). If that is not their job, where will that support come from?

14. How much unemployment among doctors, nurses and other clinical staff is the government willing to tolerate?

15. What is the job description for the chair of the NHS independent board? Will it be attractive to the kind of person with unquestionable “independence”, influence and authority?

16. Will the independent board’s commissioning guidelines be compulsory? Can they be ignored by GP commissioners?

17. Will the English language test for NHS staff apply to existing employees? If not, why not?

18. Are personal combined health and social care budgets still part of the government’s plans?

19. Is the government still enthusiastic about providing personal health records via Google and/or Microsoft’s health vault? If so, what is the future for Healthspace?

20. Does the government expect the proportion of NHS-funded care provided by the private and third sector to increase through patient choice? If not, why offer it?

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