Daily Insight: NHS England gets a wriggle on

Decision making déjà vu

Last week NHS England launched a consultation on a set of proposals for how it should prioritise investment in new specialised treatments.

If this gives you a distinct feeling of déjà vu, you’d be forgiven.

Last summer the national commissioner ran a consultation on the “principles” which would inform its prioritisation. In fact, the process has been dragging on since 2014, when the threat of a legal challenge forced NHS England to drop its proposed solution – a “scorecard” – and go back to the drawing board.

It turns out NHS England has replaced the maligned scorecard with a much more reassuring “matrix”, which will be used to help make decisions about which treatments to fund by charting patient benefits against costs.

While the process to arrive at a prioritisation methodology may feel interminable, it is important. Patients and clinicians expect transparency when it comes to the decision making that will determine which new drugs, devices and interventions the NHS will fund out of its scarce resources.

It also plays into the wider story about the huge pressure on NHS England’s specialised commissioning budget. The commissioner is taking a number of steps to contain cost pressures linked to the arrival of expensive new drugs, such as rationing access to NICE-approved hepatitis C drugs.

One commentator told HSJ that this latest set of proposals was about NHS England giving itself “wriggle room on what it has to fund”, to help it get a grip of specialised commissioning costs.

Hope and trepidation for NAO review

On Friday afternoon HSJ broke the story that the National Audit Office has started investigating cracking up of the Cambridgeshire and Peterborough £725m older people’s contract – which Labour peer Lord Hunt called for in an interview with HSJ earlier this year.

The public spending watchdog’s probe will be the fourth into the UnitingCare Partnership deal, following NHS England’s and the Cambridgeshire and Peterborough CCG’s own reviews.

HSJ readers have been having their say on the NAO investigation and the wider implications of the contract’s collapse:

“Good – at last some proper forensic analysis and a report to be published by people who do not worry about upsetting someone further up the chain. We need to know where the accountability and responsibility on all sides fell down and work out how not to repeat this complete shambles.”

“That the contract fell apart was bad news. That we have to move to a fourth report to have any chance of getting to the bottom of things does those previously (and currently) involved no credit whatsoever.”

“I hope it does not prevent innovation… The problem here is the NHS procurement framework which forces bidders to cut each other’s throats in the final stages until the NHS ends up with a contract that is financially unrealistic.”

“The bottom line is that the expectation of the CCG was unrealistic… That no-one had the nous to manoeuvre themselves out of this hole says all you need to know about commissioning, procurement and contracting in today’s NHS.”

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