Re-considering reforms
Another busy day with the journals but first the daily happenings:
The Financial Times carries quotes from the regulators asking for clarity on the extent of reforms.
Ministers must be clearer about how far they want to use competition to drive improvements in the National Health Service, the two big existing regulators of NHS and private care have warned.
“It is clear that the new regulator will have a competition function,” Anna Walker, the Healthcare Commission’s chief executive told the Financial Times as it submitted its formal response to the government’s health care regulation review.
“But it is not clear from the department’s document whether the function will be to police anti-competitive behaviour, or to promote competition. These two roles are very different”.
Her warnings were echoed by Monitor, the foundation trust regulator, in its response.
“Our view is that greater clarity is needed and that you need to decide on the policy before you can decide how to regulate it,” it said.
I’m glad to see this question articulated by these bodies as there has been little or no public debate.
The BBC covers the report first headlined in Pulse by the National Primary Care and Development Centre’s that
Moving care from hospitals into the community - a key government policy - will not always save money and may put patient safety at risk.
The analysis raised concerns over GPs doing minor surgery, and the cost of specialist care in the community.
Initiatives such as having specialist clinics in the community or putting diagnostic equipment into GPs’ surgeries might not be cost-effective because patients could be dealt with more efficiently in hospital, the report warned.
According to Professor Martin Roland “While there might be benefits to patients in terms of convenience for the new arrangements, the government needs to think very carefully about whether that’s worthwhile in terms of increasing costs and possible quality problems.”
I reviewed the study by the SDO last week which covered similar ground & pointed out the fallacies underpinning a number of initiatives.
A Department of Health spokesperson said the public supported moves to provide care closer to home.
“The shift in care is not a short-term gimmick dreamt up in the corridors of Whitehall, nor is it a cost-saving measure to appease the bean counters.
“It is all about providing NHS patients with what they want - the right care, in the right place, performed by the appropriately skilled person.”
The point is that the priorities are wrong. There are compromises being made on effectiveness & clinical safety, not to mention that DoH holy cow, efficiency. However when the evidence shows that the proposed solution is not appropriate or cost effective, I would hope that the Department modifies its policies accordingly.
There is also coverage in the HSJ of the Healthcare Commissions plans to change the annual healthcheck for 2007-08.
One of them is performance assessment for commissioning. This will be used to assess how effectively primary care trusts commission services on behalf of communities, and would come into effect in 2008-09.
Taking guidelines drawn up by consultants McKinsey as a starting point, the consultation will also ask PCTs the best way to assess commissioning. It asks whether commissioning should be assessed in terms of outcomes achieved for resources invested. And it asks for views on the range and type of information required.
The problem is that there are two approaches to healthcare. One looks just at the transactions between provider & patient, the other taking a holistic view of all factors including social care requirements. I am beginning to fear that there is too much of a focus on the first model & we are losing the ethos of healthcare provision. I would hope that the consultation takes proper account of this problem.
Some more on MTAS from the Telegraph who cover the Royal Society of Medicine coming out against it.
We are also treated to comments from Boris Johnson about MMC.
Which is not surprising, since the final ludicrous achievement of the Blair NHS is indeed to have boosted the number of junior doctors - and by a feat of almost superhuman incompetence to have timed this sensible adjustment with a dramatic cut in the number of jobs available.
Finally, my mistake was paying any attention whatsoever to these idiots. Will the next edition feature their culpability in introducing MMC?