Q&A
the cycle which is about needs assessment and securing the best service against that need within the available resources. So when people ask – can GPs commission? I say we do that anyway. It’s called consultation and referral. Te act of sitting with a patient and taking a history – that’s a need assessment. And then saying your needs can be best met with hospital and a referral – that is commissioning.
Some critics ask if it is really necessary to abolish PCTs. Why not just add more GPs to PCT boards?
Yes. I’ve heard that protectionist outlook and mainly from personnel currently working in PCTs. But that’s just plastering over the cracks. What the bill is for – is legislation for outcomes and
accountability. Now that’s saying we’ve got to have a major cultural and behavioural change in the delivery of care in our NHS. And that ain’t going to happen by just supplanting a few managers with doctors, or adding a few doctors to the current structures. It’s been recognised that our NHS needs major change.
Tere’s been, for a long time, year-on- year growth in the NHS budget. In 1995 the turnover of the NHS was around £32 billion; by 2010 it was over £100 billion. If a company was guaranteed that sort of growth over a15-year period, whatever their annual outturn and outcomes, they might just get complacent or not be as
SUMMER 2011
efficient as possible. In the NHS we’ve had this massive investment but not the concomitant improvement in outcomes. We still have areas of poor health and inequalities, urgent care is broken and long-term conditions are largely managed in the wrong sector. Using international comparative data – I think our report would be ‘could do better’.
Is competition a good thing in a national health service?
Competition within the market has always been a good thing – and it’s there inherently within the ‘NHS family’. Hospitals compete against each other; GPs do too. This established competition has worked to drive up quality and is desirable. The more contentious issue is competition for the market. And that’s something new in terms of increasing the plurality of care provision. I think we’ll get it right by saying competition for the market is desirable when commissioners find a gap, or poor or inadequate provision in local services. Or we as commissioners – the clinical community – start to describe a care pathway to which a current provider says: ‘sorry we can’t deliver that for you’. Or there is no one to deliver it. Therefore what do you do? Do you continue with poor provision or do you find a new provider for the market through the any-qualified- provider route?
Do you think the reforms will mean more private industry in healthcare provision? I don’t. If you understand the any- qualified-provider programme – it’s not always that attractive for new entrants. People tend to think it’s hands up anybody who wants to do NHS work and we’ll give you a contract and a load of dosh. It’s not. It’s saying where there is a need to develop a new service or the current service does not meet the needs of patients, then let’s have a new provider – if they meet NHS standards and can supply the estate and the staff at their own set-up costs and can deliver a full care pathway, not cherry pick a part of the care pathway. Tey may be awarded an NHS contract without having to tender – but so may others in competition for patients. And importantly that contract does not guarantee any volume of work or income. Payment is made on a cost-per-case basis using PbR and the national tariff for the service provided. Some may wish to do this. Many won’t.
Do you think 2013 is a reasonable timescale for implementation of the bill? Oh absolutely. Tere is a lot of talk in the NHS about waste of resources, of time and space, all of which are important – but if we waste spirit, the current enthusiasm and innovation, that would be unforgiveable, because we may never turn that back on. Tis is the last chance to refresh the NHS and rejuvenate clinicians in terms of being proactive in the management of the public purse. If we lose that, I think that will be the end of an NHS free at the point of need and not based on your ability to pay. We are just starting to see some concern and despondency in the profession due to the pause. We’re certainly losing some of the spirit in our NHS management, but that we can salvage. But if we lose the spirit of the people delivering the service, we’ll never recover. Any longer than 2013 would be very damaging.
Tere is a big appetite out there for change; the blue touch paper has been lit. If we start to say, oh, let’s think again, not do it, and we lose the momentum already gained particularly within the clinical leaders, and turn off that leading edge which is already starting to re-engineer local services. If we lose that, we haven’t got a chance. Interview by Jim Killgore, editor of
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