Published: 24/02/2005, Volume II5, No. 5944 Page 8
The detail behind the Conservatives' proposed redirection of NHS reform was revealed to HSJ by health spokesman Andrew Lansley this week.
Mr Lansley was speaking after the publication of the Conservative's Action on Health manifesto, which set out over 30 changes in policy that would follow a Conservative general election victory.
The manifesto includes action to tackle hospital-acquired infection, reduce waiting lists, improve public health and re-organise the commissioning of care (see opposite).
Expanding on these proposals Mr Lansley sketched out an NHS in which:
the number of primary care trusts was reduced to a 'maximum' of 150;
central targets were abandoned for acute trusts, but retained for public health and elements of primary care;
appropriate waiting times would be set by the National Institute for Clinical Excellence;
foundation trust watchdog Monitor would become the regulator for a mixed market of public and private sector secondary care provision;
the Healthcare Commission would have to radically reform its proposed approach to assessing NHS performance;
primary care trusts would lose the ability to restrict the use of practice-based budgets;
national procurement of independent treatment centres would be abandoned.
The Conservatives would abandon all 'centrally set targets on hospitals' and stop the Healthcare Commission inspecting trusts on the basis of core and developmental standards set by government. Mr Lansley claimed these were largely based on the government's planning and priorities framework and contained relatively few clinical standards.
However, NICE would take on a much wider role - producing 'clinical standards' on most aspects of healthcare from hospital-acquired infection to cancer care to niche areas of chronic-disease management such as speech therapy after a stroke.
Mr Lansley said these standards could include guidelines on the appropriate waiting times for specific types of treatment.
These standards would be the basis of the Healthcare Commission's inspection regime, provide the framework for GPs' commissioning decisions and inform patients of what treatment they should expect.
Mr Lansley said he recognised the bureaucratic 'risk' posed by a growth in NICE standards, but said this would be obviated by the fact that they would be 'evidence-based', 'produced in part by those who have to implement them' and take into account 'cost-effectiveness'.
The opposition health spokesman said a Conservative election victory would see an immediate 'progressive transfer of [commissioning] budgets to practices.' From April practices have a right to an indicative commissioning budget. A Conservative government would remove the ability of PCTs to govern how these were used.
Mr Lansley said that, as NICE guidelines were produced for specific conditions, practices would then be given 'specific sums' to spend on the relevant patient population. Patients with long-term conditions would be given choice over treatment specified by NICE, sometimes using direct payment to access independent providers.
Mr Lansley said he hoped that a 'significant proportion' of long-term conditions would be covered by NICE standards by the end of the next parliament.
Practices' influence would be further strengthened by making the delivery of commissioned services the second and final element of the Healthcare Commission's inspection regime.
The increased commissioning role of practices would see a reduction in the number of PCTs that would be responsible for commissioning emergency care and public health. Mr Lansley said it was unclear how far the rationalisation would go: 'There should be a maximum of 150, but there could be considerably fewer.' All strategic health authorities would be abolished, but acute trusts could see significant growth under a Conservative government. With all trusts becoming foundation hospitals by April 2007 and freed from the prudential borrowing requirements placed on them under the current administration, Mr Lansley claimed some NHS hospitals would expand. He suggested this was particularly true of specialist hospitals with 'world class brands, like the Marsden'.
There was 'very little likelihood of private hospitals setting up in competition' with such centres of excellence, Mr Lansley said. But he said the Conservatives would encourage independent sector growth by giving it the 'right to supply' to the NHS.
Mr Lansley said a 10-15 per cent increase in capacity was needed to end waiting lists. But this was on the basis that a large number of those paying for private healthcare did not return to the NHS. He said that Conservatives' plans to pay contribution to the costs of private healthcare were designed to stop this happening. Patients attending hospitals which charged above NHS costs would be given a state subsidy of 50 per cent of the NHS cost.
In a significant expansion of its role, Monitor would become the regulator of the 'managed market' consisting of both NHS and private hospitals. It would license independent hospitals to supply the NHS if they met the relevant standards. Monitor would also be responsible for 'the structure of the [payment by results] tariff'.
With the independent sector given the right to supply the NHS, Mr Lansley said there would be no need for the national procurement of independent treatment centres.
However, he made it clear a Conservative government would honour any contracts that had been signed by the time they won power.