SECOND OPINION
Former Health Minister Lord Owen is a staunch critic of the NHS reforms. Here he explains how to achieve a more effi cient, choice-based health service in another way.
T
he Coalition unexpectedly and inexpli- cably forged ahead with legislation for NHS reforms of staggering ineptitude. The Health and Social Care Bill rushed forward is not just massive, running to 353 pages, but challenges vital aspects and principles of the NHS.
It is necessary to clarify those principles and make a distinction of an internal market in the NHS, which is essential, and an external market, which is destructive.
How to achieve effi ciency and choice
A future integrated care strategy requires community-based care closer to home for people with long-term conditions and needs to develop patient pathways to support self- management of their conditions. This is likely to require support from care providers beyond the traditional NHS, particularly in hard-to-reach communities. These provid- ers will often be social entrepreneurs and charities.
All of these desirable developments are cur- rent practice, and are fully compatible with the NHS internal market, with the NHS as the preferred provider.
Mental health organisations have long been working through these kinds of strategic alliances with other providers in an integrated delivery strategy made up by a form of plural supply chain. Doing so also, for the most part, amicably. Crucially, this has been done on the basis of co-operation between providers rather than competition, although there is already competition in the
18 | national health executive May/Jun 11
internal market against tenders for different supply chains. It needs to be recognised that in end-of-life care, hospices and other charitable organisations supply most of the care already, within the framework of the internal market.
Another way of proceeding, compatible with the internal market, is that developed by the Cystic Fibrosis Trust. Starting as a Payment by Results (PbR) development site, they introduced a mandatory national currency for cystic fi brosis care with local prices. The currency comprises a complexity-adjusted yearly banding system, using seven bands of complexity, with no distinction between adults and children. The bandings are de- rived from clinical information including cystic fi brosis complications and drug re- quirements. They range from band one, in which patients have the mildest require- ment, with outpatient treatment two or three times a year and oral medication, up to a band for patients in the end stage of their illness on intravenous antibiotics for more than 113 days a year.
Sensibly, the Health and Social Care Bill makes suitable provision in Clause 11(3) for the Secretary of State to require the NHS Commissioning Board to arrange for spe- cialised services, such as is currently pro- vided for complex conditions such as cystic fi brosis.
Financial savings
Yet, what is never clear from the Bill is ex- actly how it will help the NHS to stay within its substantially reduced budget, let alone
deliver its effi ciency savings. The NHS in 2011 faces a unique period of fi nancial con- straint. From an historic trend of real annu- al budget growth averaging 3.8%, this more than doubled from 2000 to 2005. The NHS expects to see its budget grow by just 0.1% per annum from 2010.
David Owen served as a health minister from 1974-1976. He worked as a doctor before he became an MP.
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