The Department of Health may have to start justifying its detailed spending plans to the Commons health committee, HSJ has learned.
Until now the committee has only scrutinised DH spending retrospectively. However, Conservative committee chair Stephen Dorrell has told HSJ he wants to re-establish the principle of Parliamentary accountability over NHS spending and will, therefore, be demanding to see the DH’s so called supply estimates - the twice yearly submissions departments make to Parliament to request resources.
The move would give the committee the ability to call for a parliamentary debate on any spending submissions it deemed inappropriate.
The change is a further indication of Mr Dorrell’s desire to increase the influence of the health committee.
In an interview in which he was critical of how Mr Lansley has articulated his reform programme, the former health secretary said there should not be any “no go areas” in debate over reform.
This included “evolving commissioning” towards a US-style health maintenance organisation model where commissioning organisations would be divorced from geographical areas, allowing patients to choose the commissioners to hold their personal NHS budget.
The recent development of a “person-based” NHS allocation formula - already in use by the DH - has brought the service closer to being able to assign each citizen with an accurate and potentially portable budget.Mr Dorrell said the main impediment for introducing such a system immediately was the inability of the NHS to adequately account for individual patient transactions.
The evolution towards a model based on a small number of nation-wide commissioners which patients could chose between freely was not ruled out by the white paper, according to the health committee chair. Although it refers to GP commissioning consortia having “sufficient geographic focus” to take responsibility for “locality-based services”, Mr Dorrell said that merely reflected the “current state of play”.
He said: “I think it’s a first tentative step down the [HMO style] road. I took that as the first steps in the breaking up of the iceberg, not the refreezing of it.”
Mr Dorrell also wanted to reopen discussions on the sale of GP practice goodwill. At present practices are not able to put a commercial value on the size of their patient lists. That means new market entrants can only purchase a practice’s premises, not its NHS contract - a condition analogous to baring the new owner of a commercial business from purchasing the customer order book.
Mr Dorrell said that while the arguments were “finely balanced”, thought should be given to how arrangements disincentivised underperforming practices from exiting the market.
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What Dorrell says matters, and his message to the NHS is clear
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MPs want power to scrutinise DH spending plans in detail