NHS board?
The FT seems to be taking the idea of an independent board to manage the NHS seriously.
Proposals to create an “NHS headquarters” or a separate “management executive” within the Department of Health are being developed by David Nicholson, the chief executive of the health service.
The move would be the first step towards the creation of a more independent board to run the £90bn business the health service is about to become, reducing the day-to-day involvement of politicians.
Gordon Brown, the chancellor, is reported to be considering the idea as one of his early acts in office, assuming he becomes prime minister.
Caution is my main thought here. Will it be possible for an even smaller number of individuals to affect policy than is the case currently?
Since becoming chief executive in September, Mr Nicholson has built up his team of policy and communication advisers and has retitled jobs to reflect a more business-like approach. His principal private secretary is “head of operations” and his NHS board now consists of the 10 heads of the key strategic health authorities.
But the proposal to set up a management executive would take this much further. Politicians would still raise the money from the Treasury and set objectives, standards and priorities. But the executive would be formally charged with delivery and held accountable by ministers who would try to resist what some see as their over-involvement in operational matters.
The executive would be likely to have its own commissioning, finance and medical directors, separate from the chief medical officer and departmental structures.
The SHA heads are not independent, being appointed by & answerable to the govt. What is needed is more openness & wider discussion, not less. Is the direction the NHS is going in with providers becoming businesses, accountable to regulators and commissioners, the right one? Is the competition & choice agenda the right one for the system?
What drew my interest though was Allyson Pollock in the Guardian.
The claim that public-sector schemes have average cost overruns of 73%, and time overruns of 70%, is constantly repeated to support the claim that PFI is value for money. But on closer examination it transpires that the only figures the government is willing to release derive from false data commissioned by the government from the PFI industry.
Of the five studies cited by the Treasury as proof of PFI efficiency, only one contains any data. Two reports by the National Audit Office were based on interviews with managers of PFI projects, and the authors themselves conclude that it is not possible to judge from such evidence how the method of procurement affected the results. A third study by a private company contains no comparative data to support the claim. A fourth, by the Treasury, remains under wraps, and repeated freedom of information requests have been refused on the grounds that “disclosure would be detrimental to the commercial interests of the specific PFI contractors”.
The only report that contains any comparative data was commissioned from a consultancy and engineering firm called Mott Macdonald. This study is very curious. Full cost and time overrun details are provided for just three PFI schemes, although at the time of the study 451 PFI deals had been completed. Mott MacDonald claimed that it had difficulty getting data on other projects. The report then compares these three with 39 public-sector schemes, although very little public procurement was going on at the time. What is more, of the 39 public-sector schemes, 20 are “non standard” - complex and difficult projects - whereas the three PFI projects are all standard. You don’t have to be a statistical genius to conclude that this is hardly comparing like with like.
Mott MacDonald also used different starting points when comparing cases. They counted cost and time overruns for PFI projects from when the case was signed off, but they started counting at a much earlier stage for the public-sector projects. Yet Mott MacDonald well knew, as consultants to the PFI industry, that one of the most striking aspects of PFI was that costs escalated between the initial tendering and the contract being signed off.
Having seen enough changes between initial tender & final sign-off in the current ISTC contracts, I have to agree with the point being made.
Meanwhile, about that New Local Ownership Programme from CfH:
NHS Connecting for Health and SHAs are still working through the details of the local ownership programme (NLOP) a fortnight after the 1 April deadline for transfer of the main responsibilities passed.
The process, which will devolve parts of the national IT programme to SHAs, has entered a ‘transition period’ and now looks unlikely to take place in full before July.
NHS Yorkshire and the Humber chief information officer Phil Molyneux said key details such as funding were yet to be finalised.
A recent NHS South East Coast board paper confirms that ‘complex negotiations are continuing’ over NLOP. It adds: ‘The initial intention was to make the substantive changes in April. The process is now running more slowly, with a view to transferring responsibilities and staff to SHAs by July.’
NLOP was launched in October to make SHAs more accountable for delivery of the programme.
It followed a National Audit Office report last year that said a critical factor in the IT programme’s success would be the support of NHS staff.
CfH will continue to take responsibility for areas such as commercial strategy and contracts with suppliers. The SHAs, working with trusts and PCTs, are to take over local delivery and implementation of products.
Does this make sense to you?
Heavily pregnant women in north Derbyshire will have to travel up to 21 miles on country roads because of plans to close the Darley Dale unit and cut community midwife numbers from 50 to 33.
Chesterfield Royal Hospital NHS Trust says each birth at the eight-bed unit costs £3,217 compared with the £1,000 allocated by the government, meaning it loses £312,000 each year. The inefficiency comes because only 120 babies are born at the unit annually compared with 2,700 at the hospital, yet it has to be staffed by two midwives around the clock.
The east Midlands already has the second-worst provision of midwives in the country, according to Guardian figures.
The trust’s head of communications, Sarah Turner-Saint, said the trust needed to save £13.8m over three years. “We’re making a loss on each birth at Darley and we can’t afford to provide this service.”
There is no point blaming the trust too much. They are forced to play by arbitrary rules & face turnaround teams with more unwanted advice if they do not comply. But the loser in all of this is the patient.
This illustrates why despite the fine statements that come out of Whitehall, the reality on the ground is rather different. And once these facilities are closed, they are unlikely to be restored, whatever is said about the top-slicing only having been temporary.
So the Choice agenda continues. I think enough has been said about it but all the papers cover it yet again.
I have not really figured out why there is so much interest in this. Why are there not rules to prevent politicians including MP’s taking an interest in researchers? John Prescott could be used as an example here.
April 11th, 2007 at 9:10 pm
>> Proposals to create an “NHS headquarters†or a separate “management executive†within the Department of Health are being developed by David Nicholson, the chief executive of the health service.
The difficulty with that is that the NHS is the healthcare industry in this country. It’s not a business, and it is foolish to treat it as such.
Aphra.
April 12th, 2007 at 9:42 am
An independent management Board would help consistency in decision making and could give representation to senior medical opinion. I have described elsewhere the ACC in New Zealand which has this sort of structure and has a huge impact on the way the medical system runs in New Zealand. Not all of it good but it does give a fair amount of autonomy to doctors and fast service to patients. Hospital management went “commercial” some years ago and then reverted to elected Boards and more power to medical staff. You can only hope that the NHS is going through the same painful process!
April 12th, 2007 at 10:44 am
The difficulty lies with the interpretation of the word “Independent” given that the current team of advisors to the NHS includes people like Chris Ham who was involved in the ill-fated reorganisation (along commercial lines) of the New Zealand medical system that you mention.
The concern is that by the time the NHS goes through the same rigmarole, there won’t be much of it left standing.
April 12th, 2007 at 12:57 pm
I found myself involved in the “unbundling” of community health nursing services in NZ during the re-organisation phase because I happened to be onsite advising on smokefree research, and found the details required by the management “consultants” somewhat unrealistic. People actually do choose to work for the public good (well, one would assume Labour politicians likewise) and, at some point, reforming health managers should recognise and support this. It is unfortunate that the UK govt appears to be working against such altuistic behaviour in its messy NHS organisational change initiatives.
April 12th, 2007 at 1:18 pm
Indeed, it would help if the “consultants” actually knew what they were talking about but those with suitable healthcare backgrounds are few & far between. There are usually a small number of good people on the team with the responsibility of glad-handing clients but with the bulk of the work being done by junior staff whose qualifications for the work are likely to be suspect. That is the whole consultancy model & not enough people recognise that.
April 12th, 2007 at 2:21 pm
fps
Yes it is a problem. The “frontperson” gets the contract and the employees do the work with little or no quality control. These days there are suspect delegations to the “therapy” industry (occupational, physio) who are doing well financially (in NZ at least) with contract medical and psychological assessment work which they are really not qualified/trained to do.
April 17th, 2007 at 10:59 am
[...] FT continues its coverage of proposals for an independent management board to run the NHS. Politicians and the Department of [...]
April 24th, 2007 at 4:11 pm
[...] pressure and government guidance promising every woman the option of such a delivery. The trust had said it would have to shut the rural Darley Dale unit in Matlock, north Derbyshire, because, with just 120 babies born there each year, it was losing [...]
May 1st, 2007 at 8:55 am
[...] imperatives over clinical priorities & by forcing the NHS into debt for a generation, the costs of PFI having been well debunked, so much so that we are having to bribe them to bid. “I personally [...]