Those nasty bits in the health reforms where snazzy well-loved hospital buildings were going to get “designated” as essential while boring outpatient and orthopaedic departments were cast aside as ultimately dispensable have gone, right?
Well, maybe. The government has said it remains committed to replacing the system of bungs – sorry “local support” – that have been used to prop up struggling hospitals. That keeps open the possibility the risk pool – whose provisions still sit in the Health Bill – could be amended to create a giant slush fund, to, er, bail out struggling hospitals; only in an open and transparent way.
But how much will each organisation have to pay into that fund? Topslicing everyone a pro-rata amount seems unfair.
The government’s thinking on care home regulation in light of Southern Cross perhaps gives a clue as to how it might proceed. There, the front-running proposal is to ask care home operators to either take out an insurance bond or offer up a share of their business, as security against it going under.
The emphasis is on ensuring there are sufficient resources to provide continuity of care for residents if an operator collapses.
That implies the size of the security required will not just be based on a company’s credit worthiness, but also on the number and, well, case mix, of the residents whose care needs to be protected.
If the market in a given area is such that the residents at one very standard care home could be quickly moved into a similarly standard and neighbouring home, the operators would – perhaps rightly – complain if the security demanded to safeguard continuity of care was anything other than minimal. Cruelly put: the world would not stop turning if one or the other home collapsed.
The same might not be said of a home in an under-served area, catering for residents with particularly complicated or specialised needs. So the security in that case – be it a bond or a premium into a risk pool, and which either way gets paid by the commissioners – would need to be higher.
I’d call that latter facility an “essential service”. The challenge for our beleaguered civil servants, it seems, is to avoid doing so.
Sally Gainsbury is a news reporter for the Financial Times.