NEWS
T
he NHS reforms remained in a political and legislative limbo as NHE went to press, as ministers continued to stake out ‘red lines’ and attempt to drag the Health & Social Care Bill in their direction while seeking to safe- guard their own careers and save as much face as possible in an increasingly spat.
acrimonious public
Health Secretary Andrew Lansley has already given much ground in the face of opposition from much of the medical profession and his Liberal Democrat col- leagues in Government. While he retains the full-throated support of many Conservative backbench- ers, it has become clear that the reforms have become an intra- Coalition battleground in which ei- ther he or Deputy PM Nick Clegg will emerge the loser. Speculation continues about whether Lansley will be able to keep his job if his cherished reforms are gutted to the extent that Lib Dem MPs ap- pear to be demanding to secure their votes.
But it has been suggested that Clegg may have gone too far in his public brinkmanship over the
Bill, in particular his assertion that it will need to go back to commit- tee stage in Parliament because of the scale of changes required.
Backtracking
Although Lansley appears to have accepted the downgrading of the role of Monitor and less empha- sis on NHS competition, some of the other changes to the reforms being mooted – such as making clinician-led commissioning vol- untary, rather than compulsory – could undo much of the reason for his reforms in the first place. It has also been suggested that there will be a potentially greater role for hospital doctors and nurses in the commissioning process.
If compromise is struck in this direction, it could mean the con- tinuation of some PCTs, or very similar successor bodies, far into the future – even though some are already struggling to retain and re- cruit suitable staff because of the uncertainty.
The future
Chairman of the NHS Future Forum, Professor Steve Field,
who is a former chairman of the Royal College of GPs and seen as a supporter of the reforms in prin- ciple, had a big impact on the de- bate when he said in an interview that aspects of the reforms could be unworkable and could destabi- lise local hospital services.
He told the Guardian newspaper: “If you had a free market, that would destroy essential services in very big hospitals but also might destroy the services that need to be provided in small hospitals.”
Field suggested there could be protected core services that each English hospital had to provide to ensure the NHS remained a prop- erly national service, such as A&E and maternity units. Smaller hos- pitals could be given subsidies to ensure their long-term future, he suggested.
Mike Farrar, the new chief execu- tive of the NHS Confederation, said: “We have been clear that we support the Government’s objec- tives of empowering patients and giving doctors and nurses a great- er role in the planning of services. But we urgently need greater clar- ity on a range of issues, such as
how commissioning organisations will be governed and accountable to the public, and how competi- tion and integration of services will be regulated if we are to have confidence that the reforms will achieve their aims.”
He added: “Learning to do more with less is going to be tough and our health service faces its most challenging period ever in the years ahead. NHS staff have to rise to the challenge of im- plementing these reforms while achieving large-scale efficiency savings. Policy makers must rec- ognise the enormous scale of this task, and reflect it in the timetable for reform, allowing greater flex- ibility for achieving foundation sta- tus and commissioning consortia to get up and running.
“This makes it essential that the outcome of the listening exercise provides reforms that are targeted only at those areas of the service that need change and help us deliver the productivity and efficiency challenge.
“The Government must get these reforms right. If they don’t, pa- tients will be the losers.”
J
im Easton, the NHS National Director for Improvement
and Efficiency, has written to all chief executives inviting them to join the ‘Product Pricing Project’ aimed at revealing the prices paid for different NHS organisations for the same clinical products.
This was a key concern of a recent National Audit Office (NAO) report into NHS consumables procurement, which found a wide range in the prices being paid, and found that millions of pounds could be saved if all trusts paid the same as the one getting the best deal.
The NAO’s Mark Davies, director of health value for money, and report co-author Grace Beardsley, an audit manager at the NAO,
described the problem in detail to NHE in our last edition.
In Easton’s letter, the NHS chief executives were also invited to join a Department of Health workshop to gain practical examples of how they can save money through improved procurement and input into the national procurement strategy.
Easton wrote: “You may be concerned that you have signed confidentiality agreements with some suppliers which do not permit you to disclose the price that you pay.
You will need to consider each agreement individually, but I would encourage you to view the transparency of these prices as
4 | national health executive May/Jun 11
something which is in the interest of the public purse, and an issue on which the NHS should be publicly accountable.
“Pricing information in itself is
not necessarily confidential, particularly where that information is either already in the public domain or there are public interest grounds for information.
disclosing that
“Improving the efficiency of the procurement of goods and services in the NHS is key to saving money so resources can be redirected to the front line. Leadership and commitment to change at trust level is needed to make this happen.
However, I also recognise that “Whilst the National QIPP
Procurement Workstream has a number of projects in place with this aim, the recent NAO report on the procurement of consumables in the NHS has made it clear that a more developed national strategy is needed, and that this needs to be done in conjunction with the NHS.
“We must be confident that we have done all that we can to ensure that procurement spend is as low as it can be so that every penny saved can be ploughed back into frontline services.”
there are system changes and national to
be in
initiatives which need place
to create an
environment where changes of this kind can flourish.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84