Posts Tagged ‘Health policy’

Government names quangos to be cut

By Mike Broad - 27th July 2010 10:22 am

A range of health quangos will either be abolished or merged to cut bureaucracy and save money, the government has announced.

The changes will reduce the number of quangos from 18 to between eight and ten, with the government claiming it will deliver savings of over £180m by 2014/15.

The biggest victims of the cull are the Health Protection Agency, which protects the health of the population, and the National Patient Safety Agency, which promotes patient safety and manages the National Clinical Assessment Service, the National Research Ethics Service and confidential enquiries. Its safety functions will be retained and transferred to the National Commissioning Board.

The HPA will have its functions transferred to the secretary of state as part of the new Public Health Service.

Vivienne Nathanson, the BMA’s head of science and ethics, questioned the abolition of the HPA saying: “Public health messages are often more effective coming from this agency than the government.”

Other quangos which will disappear include: the NHS Institute for Innovation and Improvement, which spreads new ways for working, the Alcohol Education and Research Council and the Appointments Commission.

As part of the wider reforms set out in the White Paper, Equity and Excellence: Liberating the NHS, the review assessed whether the work of each of the Department of Health’s 18 quangos remained essential. It also looked at whether work is being duplicated or could be better carried out by a different body.

Health Secretary Andrew Lansley said: “Over the years the sector has grown to the point where overlap between organisations and duplication of effort have produced a needless bureaucratic web. By making sure that the right functions are being carried out at the appropriate level, we will free up significant savings to support front-line NHS services.”

What’s planned for the other quangos?

- Care Quality Commission, which regulates health and adult social care provision.

Proposal: Retain as quality inspectorate across health and social care, operating a joint licensing regime with Monitor. Current responsibility of assessing NHS commissioning moves to the NHS Commissioning Board. May gain functions from other organisations, e.g. HTA and HFEA.

- Monitor, which assesses, licences and monitors foundation trusts

Proposal: Retain and make an economic regulator, operating a joint licensing regime with CQC.

- National Institute for Health and Clinical Excellence, which provides national guidance on the promotion of good health and the prevention and treatment of ill-health.

Proposal: Retain, and put on a firmer statutory footing by establishing it in primary legislation. Expand scope to include social care standards.

- Council for Healthcare Regulatory Excellence, which oversees professional regulators

Proposal: Remove from the sector. Make a self-funding body by charging a levy on regulators.

- General Social Care Council, which regulates social workers.

Proposal: Transfer the regulation of social workers to the Health Professions Council, which will be renamed to reflect its new remit.

- Health and Social Care Information Centre, which collects and provides health and social care information.

Proposal: Retain, and put on a firmer statutory footing by establishing it in primary legislation. National repository for data collection across health care, public health and adult social care. Clearer focus on data collection, with a close working relationship with the NHS Commissioning Board.

- Human Fertilisation and Embryology Authority, which regulates human embryo storage, research and assisted reproduction treatment

Proposal: Retain for the time being, with the aim of transferring its functions by the end of the current Parliament. In the meantime, the government will examine the practicalities of how to divide the HFEA’s functions between a new research regulator, the Care Quality Commission and the Health and Social Care Information Centre.

- Human Tissue Authority, which regulates the removal, storage and use of human tissue and organs.

Proposal: Retain for the time being, with the aim of transferring its functions by the end of the current Parliament. In the meantime, the government will examine the practicalities of how to divide the HTA’s functions between a new research regulator, the Care Quality Commission and the Health and Social Care Information Centre.

- Medicines and Healthcare products Regulatory Agency, which regulates medical devices and medicines.

Proposal: Retain, but with the expectation that it will undertake its regulatory duties in the most cost effective way.

- National Treatment Agency for Substance Misuse, which works to increase the availability, capacity and effectiveness of drug treatment in England.

Proposal: Abolish and transfer functions to the Secretary of State as part of the new Public Health Service.

- NHS Blood and Transplant, which provides blood, organs and associated services to the NHS.

Proposal: Retain, and commission an in-depth review of opportunities to make more commercially effective. Transfer Bio-Products Laboratory out of NHSBT into a Department of Health owned company.

- NHS Business Services Authority, which provides central services to the NHS

Proposal: Retain in short term, and commission commercial review to identify potential for increased commercial opportunities.

- NHS Litigation Authority, which handles negligence claims and works to improve risk management practices in the NHS.

Proposal: Retain, and commission an industry review to identify potential opportunities for greater commercial involvement.

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NHS outcomes framework consultation: submit your views

By Mike Broad - 25th July 2010 3:13 pm

The white paper, Equity and Excellence: Liberating the NHS, set out the government’s intention to achieve better outcomes in the NHS and become more responsive to patients’ needs.

The government also launched a consultation on a new outcomes framework that aims to refocus the NHS on the outcomes achieved for patients rather than the process targets of the past that had no clinical justification. It begins to describe what the framework will look like.

It includes a set of national outcome goals which patients and the public can use to judge the overall performance of the NHS and hold the government to account for progress. The framework and the national outcome goals will form a combined mechanism by which the health secretary can hold the new NHS Commissioning Board to account.

Defining and measuring quality is central to meaningful accountability. The NHS Next Stage Review, led by Lord Darzi, helped the NHS define quality as: the effectiveness of the treatment and care provided to patients; the safety of the treatment and care provided to patients; and the broader experience patients and their carers have of the treatment and care they receive.

In terms of measuring these three areas, the government believes it is legitimate to look at:

• the structures of care - based on robust evidence, how should treatment and care be structured in order to maximise the chance of a good outcome for the patient?

• the processes of care - based on robust evidence, what are the things that should be done to maximise the chance of a good outcome for the patient?

• the outcomes of care - what actually happens to the health of the patient as a result of the treatment and care they receive?

However, at a national level the focus and accountability should, as far as possible, be centred around the outcomes of care. Locally, the structures and processes of care will need to be monitored but focusing on these too heavily at a national level can lead to a distortion of clinical priorities and risks creating a whole system of accountability that it is more concerned with the means than the result - an accountability system that has lost sight of the purpose of the NHS.

While the outcomes framework is intended to sharpen the accountabilities in the system for delivering better and more equitable outcomes, it is not about setting priorities for the service. It will be used by the health secretary as a balanced scorecard or dashboard to monitor the progress of the NHS in delivering care to patients.

Accountability can only be effective if it is matched by transparency. The data against each of the outcomes that are presented in the framework will be made publicly available, so that the NHS and public can see the progress of the NHS for themselves.

Striving to free professionals from excessive bureaucracy means measuring the progress of the NHS against outcomes that are clinically relevant and that professionals themselves recognise as accurately tracking the delivery of improved quality and outcomes for patients.

The framework should also recognise the importance of reducing inequalities and promoting equality. For example, because of the social gradient in most health outcomes, the most potential health gain will often be available from the lower reaches of the gradient, from disadvantaged groups and areas.

The government’s vision for the NHS is for it to be a world leader in healthcare provision. However, outcomes included in the framework should not be selected solely in areas where the NHS is performing less well than other international healthcare systems, as this perspective may not identify what matters most to patients. International comparisons can only be based on what comparable data is available and this may not always reflect the most important quality improvement challenges facing individual healthcare systems.

The consultation document suggests five outcome domains and is seeking views from clinicians and patients on the structure and the core principles that should underpin the development of the framework, as well as the more specific outcome measures that should be used.

The proposed domains are:

1. Preventing people from dying prematurely.

2. Enhancing the quality of life for people with long-term conditions.

3. Helping people to recover from episodes of ill health or following injury.

4. Ensuring people have a positive experience of care.

5. Treating and caring for people in a safe environment and protecting them from avoidable harm.

The consultation asks two key questions about these: Do you agree with the five outcome domains that are proposed for the NHS Outcomes Framework? Do they appropriately cover the range of healthcare outcomes that the NHS is responsible for delivering to patients?

Once set, it will be for the NHS Commissioning Board to determine how best to deliver improvements against the selected outcomes by working with GP consortia and making use of the various tools and levers it will have at its disposal. For example, the board will be able to commission quality standards from NICE, which it will then use to provide more detailed commissioning guidance on how best to meet the national outcome goals included in the framework.

The board will also be able to draw on these quality standards to support it in designing payment mechanisms and incentive schemes such as the Commissioning for Quality and Innovation Payment Framework.

The first publication of the framework will, as a starting point, use existing outcome indicators for which data can be collected. This will mean that the NHS Outcomes Framework for 2011/12 may not necessarily meet all of the principles set out in this chapter. However, the nature of the changes to the NHS landscape that were announced in the white paper and the time lag to develop new indicators means that the NHS Outcomes Framework will evolve over time. It will be reviewed annually.

Health secretary Andrew Lansley commented: “Instead of politically motivated targets which lack clinical evidence, we will measure the outcomes that are most important to patients and that are relevant to healthcare professionals. These will be backed up by authoritative, evidence-based quality standards that will ensure everyone understands how those outcomes can be achieved.

“I want to hear the views of healthcare professionals, patients, carers and the public on how the new system should work, and what we should measure to ensure the NHS is focussed on what is important to patients and what improves their overall experience of NHS care.”

Views can be submitted via email at nhswhitepaper@dh.gsi.gov.uk. The government will publish a response to the consultation prior to the introduction of a Health Bill later this year.

Read the full consultation document.

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Health secretary calls for medical leadership

By Mike Broad - 2nd July 2010 12:50 pm

The health secretary urged clinicians to lead quality improvements in the NHS, at the BMA’s annual representatives meeting.

Andrew Lansley said he would empower doctors and free up the service to deliver results in return for the profession’s support and leadership in delivering change.

He said key priorities for the government were to continuously improving outcomes for patients - “not inputs or processes, but results” - and to make the NHS sustainable through prioritising prevention.

He said: “I can’t count how many times doctors have told me, on a personal and professional level, how frustrated they are by the way the system works. How their judgements and activities are restricted by the rigidity of the system, and how their clinical priorities have been distorted by narrow process targets.

“If we are going to achieve the outcomes we all want to see, we need to break down that system and build one that is focused on improving results for patients.”

He outlined four steps to achieving this.

The first is measuring outcomes rather than inputs. He wants to construct a national outcomes framework for the NHS which will include targets for improving one and five year survival rates for cancer and reducing premature mortality from stroke, heart and lung disease.

The 18-week target for hospital waiting times, the four hour A&E target and the 48-hour target for GP access, will all be scrapped.

Secondly, control of commissioning with be given to GPs to enable the design of more tailored services for patients.

The government also wants to introduce “proper” measures of quality across the service.

He said: “Clinicians will be accountable in a different way - not to tick-box process targets, but to quality standards.

“Standards which do not distort clinical judgement, but which are based on clinical evidence. Standards which achieve better outcomes and are comprehensible to patients so that they can hold clinicians to account.”

And, finally, improving access to information. He pointed to the National Joint Registry and 2008 National Adult Cardiac Database Report and claimed they should provide a model for how feedback can be delivered to clinicians to improve quality and outcomes.

He supports the North West’s Advancing Quality programme, which has been collecting outcomes data on five high cost and high frequency interventions, including heart failure, pneumonia, and hip replacements.

He said: “They’ve been measuring their performance - not against national targets - but against their own standards, and working to improve the quality of the service they provide.

“It’s the first time in the UK that such data has been reported on behalf of a regional health system, assured by the Audit Commission, and made available online so that the public can see exactly what’s going on.”

Lansley concluded his speech by highlighting the deal he wants to strike with the profession: “The critical issue is this: what will you do with these freedoms and responsibilities? That is a question of leadership,” he said.

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A new area of practice for the Loophole Department

By Bob Bury - 14th June 2010 9:03 am

Just when you thought it was safe to start reading the papers again, there’s a another outbreak of political twattery - this time from the new lot. Andrew Lansley wants to fine hospitals if they re-admit patients within 30 days of discharge. None of you need me to point out what a facile load of ordure this represents - others have done that already, and when even The Guardian’s health correspondent can foresee problems, it should be clear to anyone that the Secretary of State for Health has inherited his predecessors’ difficulty concerning orifice selection when making policy statements.

Still, it will open up a whole new area of practice for the Trust Loophole Department (you know, the people who dreamed up the ‘clinical decision unit’ concept to avoid breaching the A&E 4 hour wait target, and the re-badging of any nurse with more than three GCSEs as a ‘consultant’ to avoid the inconvenient tendency of real doctors to want to keep patients hanging around long enough to actually examine them). They will now be able to support the focus-group driven initiative to provide care closer to the patient’s home by establishing a complex bureaucracy to ensure that no patient gets re-admitted during the penalty period. This will give GPs a valuable opportunity to hone their skills and acquire new ones. COPD patients, discharged after their latest exacerbation, will have their day 14 left anterior descending occlusion managed for a couple of weeks by Dr Finlay and the home angioplasty team (one nurse practitioner who has ‘done the course’ assisted by a couple of slack-jawed teenagers undertaking their work-experience as Auxiliary Interventional Technicians), until they (well, the lucky few) can be admitted to the CCU for salvage on day 31. Brave new world indeed.

To think that we had high hopes of Andrew. Perhaps they really are all the same? That would be depressing.

Oh well, it won’t matter for most of us, if the Daily Mash is to be believed - we’ll all be on the beach.

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We want to see the detail before we respond

By Dr Hamish Meldrum, the BMA's chairman - 24th May 2010 11:06 am

The government has published its plans for the NHS, merging the policy commitments of the two parties. Here’s BMA chairman Dr Hamish Meldrum’s initial response in full:

“Doctors want to work constructively with the new government and we are pleased that today’s plans prioritise clinical engagement with the medical profession - it is essential that this dialogue is meaningful and does not just pay lip-service to the notion of involving clinicians in proposals for the health service.

“Despite some reassurances about funding, the NHS faces a challenging time ahead with considerable funding pressures and any plans the Government has to make for efficiency savings should be based on clear clinical evidence and involve doctors at all levels to ensure that quality of care for patients is protected.

“The BMA wants to see a lot more detail about the government’s plans before responding to many of the specific policy areas. We are already aware of some of the proposals set out for GPs and we are willing and ready to discuss these with the government. While we support sensible suggestions to improve patient access and choice, enabling patients to register with any GP practice they want will, in reality, be very complex, potentially more expensive and could threaten that important relationship between a doctor and his or her patients. We need to ask the government whether, given the current financial pressures, now is the right time to embark on such a costly venture.

“We agree that producing the best possible health outcomes must be a priority. Doctors always want to strive to improve their clinical results; however, it is essential that mechanisms for collecting and publishing data are robust, evidence-based and meaningful to health professionals and patients.

“The idea of an independent board to oversee the day-to-day running of the NHS was first mooted by the BMA several years ago and the BMA also proposed more patient and public involvement at a local level. We will be very happy to discuss the development of these proposals with the government.”

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Coalition government unveils health policies

By Mike Broad - 10:13 am

The coalition government has published its plans for the NHS, merging the policy commitments of the two parties.

The document, called The coalition: our plans for government, re-iterates the Tories commitment to marketisation of the NHS, giving patients more choice of health provider, and cutting administration costs.

It also supports the formation of an independent NHS board overseeing aspects of the NHS. And further development of NICE, and the regulators the Care Quality Commission and Monitor. 

The commitments include:

• Raising quality through much greater involvement of independent and voluntary providers.

• Giving every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices.

• Publishing detailed data about the performance of healthcare providers online, “so everyone will know who is providing a good service and who is falling behind”.

• Putting patients “in charge of making decisions” about their care, including control of their health records.

• Creating a Cancer Drugs Fund to enable patients to access the cancer drugs their doctors think will help them, paid for using money saved by the NHS through the pledge to stop the rise in employer National Insurance contributions from April 2011.

• Reforming NICE and move to a system of value-based pricing, “so that all patients can access the drugs and treatments their doctors think they need”.

• Prioritising dementia research within the health research and development budget.

• Stopping foreign healthcare professionals working in the NHS unless they have passed robust language and competence tests.

• Giving front-line staff “more control of their working environment”.

• Establishing an independent NHS board to allocate resources and provide commissioning guidelines.

There are also significant commitments in primary care including the renegotiation of the GP contract with a view to getting GPs more involved in out-of-hours care, scrapping practice boundaries and having PCT boards partly constituted by directly elected members.

At the document launch, David Cameron said coalition health policy was “more radical, more de-centralising” than either party had planned.

Commenting on the plans, BMA chairman, Dr Hamish Meldrum, said: “Doctors want to work constructively with the new government and we are pleased that today’s plans prioritise clinical engagement with the medical profession - it is essential that this dialogue is meaningful and does not just pay lip-service to the notion of involving clinicians in proposals for the health service.

“Despite some reassurances about funding, the NHS faces a challenging time ahead with considerable funding pressures and any plans the government has to make for efficiency savings should be based on clear clinical evidence and involve doctors at all levels to ensure that quality of care for patients is protected.”

The BMA wants to see more detail before commenting on specific policies.

Dr Jennifer Dixon, director of thinktank Nuffield Trust, said: “We welcome moves to provide a stronger voice for local communities on the boards of local PCT. But much-needed changes to local health services, particularly those that reduce avoidable and costly care delivered in hospitals, must not be derailed because they are unpopular. Too much care is delivered in hospitals when it could be prevented and we now need radical changes to the way patient care is commissioned, organised and delivered outside hospitals.”

Read a full list of the commitments.

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The coalition government’s priorities on healthcare

By Mike Broad - 10:06 am

The government has published its plans for the NHS, merging the policy commitments of the two parties.

The document, called The coalition: our plans for government, starts by saying the NHS is an important expression of our national values and the government is committed to an NHS that is free at the point of use and available to everyone based on need, not the ability to pay.

The government wants to free NHS staff from political micromanagement, increase democratic participation in the NHS and make the NHS more accountable to the patients that it serves.

“That way we will drive up standards, support professional responsibility, deliver better value for money and create a healthier nation,” it says.

The following are the commitments it makes on the NHS:

• We will guarantee that health spending increases in real terms in each year of the Parliament, while recognising the impact this decision will have on other departments.

• We will stop the top-down reorganisations of the NHS that have got in the way of patient care. We are committed to reducing duplication and the resources spent on administration, and diverting these resources back to front-line care.

• We will significantly cut the number of health quangos.

• We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line.

• We will stop the centrally dictated closure of A&E and maternity wards, so that people have better access to local services.

• We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf.

• We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local PCT. The remainder of the PCT’s board will be appointed by the relevant local authority or authorities, and the chief executive and principal officers will be appointed by the Secretary of State on the advice of the new independent NHS board. This will ensure the right balance between locally accountable individuals and technical expertise.

• The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations.

• If a local authority has concerns about a significant proposed closure of local services, for example an A&E department, it will have the right to challenge health organisations, and refer the case to the Independent Reconfiguration Panel. The Panel would then provide advice to the Secretary of State for Health.

• We will give every patient the right to choose to register with the GP they want, without being restricted by where they live.

• We will develop a 24/7 urgent care service in every area of England, including GP out-of-hours services, and ensure every patient can access a local GP. We will make care more accessible by introducing a single number for every kind of urgent care and by using technology to help people communicate with their doctors.

• We will renegotiate the GP contract and incentivise ways of improving access to primary care in disadvantaged areas.

• We will make the NHS work better by extending best practice on improving discharge from hospital, maximising the number of day care operations, reducing delays prior to operations, and where possible enabling community access to care and treatments.

• We will help elderly people live at home for longer through solutions such as home adaptations and community support programmes.

• We will prioritise dementia research within the health research and development budget.

• We will seek to stop foreign healthcare professionals working in the NHS unless they have passed robust language and competence tests.

• Doctors and nurses need to be able to use their professional judgement about what is right for patients and we will support this by giving front-line staff more control of their working environment.

• We will strengthen the role of the Care Quality Commission so it becomes an effective quality inspectorate. We will develop Monitor into an economic regulator that will oversee aspects of access, competition and price-setting in the NHS.

• We will establish an independent NHS board to allocate resources and provide commissioning guidelines.

• We will enable patients to rate hospitals and doctors according to the quality of care they received, and we will require hospitals to be open about mistakes and always tell patients if something has gone wrong.

• We will measure our success on the health results that really matter - such as improving cancer and stroke survival rates or reducing hospital infections.

• We will publish detailed data about the performance of healthcare providers online, so everyone will know who is providing a good service and who is falling behind.

• We will put patients in charge of making decisions about their care, including control of their health records.

• We will create a Cancer Drugs Fund to enable patients to access the cancer drugs their doctors think will help them, paid for using money saved by the NHS through our pledge to stop the rise in employer National Insurance contributions from April 2011.

• We will reform NICE and move to a system of value-based pricing, so that all patients can access the drugs and treatments their doctors think they need.

• We will introduce a new dentistry contract that will focus on achieving good dental health and increasing access to NHS dentistry, with an additional focus on the oral health of schoolchildren.

• We will provide £10 million a year beyond 2011 from within the budget of the Department of Health to support children’s hospices in their vital work. And so that proper support for the most sick children and adults can continue in the setting of their choice, we will introduce a new per-patient funding system for all hospices and providers of palliative care.

• We will encourage NHS organisations to work better with their local police forces to clamp down on anyone who is aggressive and abusive to staff.

• We are committed to the continuous improvement of the quality of services to patients, and to achieving this through much greater involvement of independent and voluntary providers.

• We will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers.

Read the BMA’s response.

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The Conservatives’ health manifesto: at-a-glance

By Mike Broad - 7th January 2010 12:43 pm

The New Year has brought the opening salvos of the general election campaign, which is expected to be held in May.

This week, the Conservatives published the first chapter of its draft manifesto - on health. They’re going to publish it chapter by chapter and are calling it a draft because they say they want public response before finalising it. 

The manifesto starts by making a commitment to keeping healthcare free at the point of use and available to everyone based on need not ability to pay.

The Tories claim that despite a massive increase in spending on the NHS, the gap in health outcomes between the UK and the rest of Europe has widened. They also accuse Labour of top-down, bureaucratic mismanagement that has undermined NHS staff and skewed priorities.

They’ve pledged to protect health spending and claim their reforms will be based on decentralisation, accountability and transparency.

A patient-centred NHS

1. The Conservatives have pledged to scrap all of the politically motivated process targets.

2. Make detailed data about the performance of trusts, hospitals, GPs and other staff available to the public online.

3. Put a focus on health results, particularly cancer and stroke survival rates and reducing infections.

4. Enable patients to rate hospitals and doctors according to the quality of care.

5. Enable patients to choose any healthcare provider than meets NHS standards.

6. Put patients in charge of their own health records, with the ability to choose which providers they share them with.

7. Open up NHS provision to include new private and voluntary sector providers.

8. Allow GPs to hold patients’ budgets and commission care on their behalf.

9. Devolve decision making to cut the cost of NHS administration by a third and transfer resources to the frontline.

10. Create an independent board to allocate resources to different parts of the country and make patient access more equal and based on need.

More accessibility and accountability

1. Deny hospitals full payment for a treatment which leaves a patient with an avoidable infection.

2. End mixed-sex accommodation and increase the number of single rooms in hospitals.

3. Reform how drug companies are paid so that any cost-effective treatment can be made available through the NHS, with drug providers paid according to the value of the new treatments.

4. Provide access to a doctor or nurse when the GP isn’t open. Stop the closure of A&E wards.

5. Give mothers choice over where to have their baby and allow new providers to deliver maternity care. Introduce local maternity networks to improve access to services.

6. Introduce a new dentistry contract that ties newly-qualified dentists into the NHS for five years.

7. Remove the rules preventing welfare-to-work providers and employers purchasing services from mental health services.

Improve public health

1. The Department of Health will be renamed the Department of Public Health to give prevention more priority. 

2. Provide separate public health funding to local authorities. Extra resources will go to the poorest areas with the worst health outcomes through a new ‘health premium’.

3. The Conservatives will provide £10m a year funding beyond 2011 to support hospices in their work with children, and introduce a new per-patient funding system for hospices and providers of palliative care.

4. Give patients with chronic or long term conditions access to a single budget that combines their health and social care funding.

5. To protect people having to sell their homes to pay for residential care in older age, everyone on retirement will have to pay a one-off insurance premium of £8,000.

Reactions to the manifesto

Anna Dixon, acting chief executive of the King’s Fund, said: “Although there is much in the draft manifesto that chimes with current government policy - more foundation trusts and more choice for patients, for example - the document signals a number of areas where Conservative and Labour policy diverge.

“An independent board, changes to the way that drugs are approved and paid for, and real budgets in the hands of GPs could significantly change the way in which the NHS operates. But more detail is needed before the impact of such policies can be properly understood.

“There are also some issues which remain unanswered such as whether a Conservative government would seek to maintain the current waiting times achieved by the NHS.

“Whichever party forms a government after the next election, they will inherit an NHS facing the toughest financial challenge in its history. Whether or not current spending is protected, demand will continue to rise and the NHS needs to figure out how to do more for less without compromising safety or quality.”

Norman Lamb, shadow health secretary for the Liberal Democrats, said: “The NHS is facing enormous shortfalls in funding over the next few years yet the Tories continue to promise extra health spending without any details of where the money will come from.

“The time has come for David Cameron to be honest with the British public. If the Tories want to pledge extra spending on health in some areas then they must admit that without extra funds it will lead to cuts in frontline services elsewhere. And if they plan to remove all central targets how do they intend to prevent a return to the waiting lists of old?

“The sad truth is that David Cameron knows his health policies don’t add up. How else do you explain the sudden U-turn today on their flagship single room’s policy?”

Dr Peter Carter, chief executive of the Royal College of Nursing, said: “Having the right number and balance of skilled staff is the key to delivering quality care and in improving people’s health. Specialist nurses also play a vital role in improving care for people with long-term conditions and we are calling on all parties to support patients having guaranteed access to these specialists.

“We are encouraged to see signs that show the Conservatives intend to take a firm stance on public health and health inequalities but we are disappointed to have not heard more about issues such as tackling alcohol abuse. Specifically, we would have liked to have heard a firm commitment for a single mandatory code to better regulate the drinks industry.”

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New boss but same old story at the King’s Fund

By Dr Clive Peedell, consultant clinical oncologist, James Cook University Hospital - 2nd December 2009 2:49 pm

A recent King’s Fund report, Making it happen - next steps in NHS reform, stated that it was essential for the government to “dispel any lingering doubt about it’s commitment to the market-based reforms” and that “the Department of Health should continue to actively encourage and support the exercise of choice”.

Considering that market based reforms of the NHS are controversial, backed by little evidence, and opposed by the BMA, it is important to try and understand why the King’s Fund is so pro-market. Also, the King’s Fund is probably the most influential health think-tank.

Its strategy is set by a board of trustees: “The role of the Board of Trustees is to agree the organisation’s overall strategic direction, in line with its charitable objectives, and to scrutinise management functions delegated to the Senior Management Team.”

The King’s Fund website states that it aims to “shape policy, transform services and bring about behaviour change”. It also states that: “The King’s Fund’s independence means we are uniquely placed to provide an objective perspective on government health policies and those of opposition parties, as well as brokering debate on key issues affecting the health service and patients.”

Considering the above statements it is interesting to note that the eight members of the King’s Fund’s board of trustees are as follows:

1. Simon Stevens - president of Global Health at UnitedHealth Group. He was previously the Prime Minister’s health advisor.

2. Dr Penny Dash - adviser to a wide range of organisations including the NHS, independent health care providers, pharmaceutical companies and private equity groups. She’s a former DoH head of strategy and planning, who worked closely with Alan Milburn, in the development of the NHS Plan. She is a partner at management consultants McKinsey.

3. Strone Macpherson - chairman of Tribal consulting. The Tribal group has been appointed to the DoH’s framework for procuring external support for commissioners, i.e. PCTs pay Tribal to help with their commissioning functions. Tribal also provides ‘technical experts’ in all aspects of funding, from PFI, LIFT and public procurement to social enterprises and boast the largest health architectural practice in Europe.  

4. Jude Goffe - a founding non-executive director at Monitor, the regulator of NHS foundation trusts.

5. Professor Julian Le Grand - former health advisor to Tony Blair and the leading academic proponent of the choice agenda.

6. David Wootton - lawyer and partner at Allen & Overy in London, an international law firm specialising in mergers and acquisitions, corporate transactions and corporate governance.

7. Dame Jacqueline Docherty - a former member of the management executive at the Department of Health, the Scottish Office, she’s now the chief exec at West Middlesex Hospital.

8. Cyril Chantler is chairman of the King’s Fund. He is an adviser to the Associate Parliamentary Health Group. This group enables parliamentarians, policy makers, healthcare professionals and the health industry to promote and discuss the national health agenda.

In view of the above membership of this board, it must be hard for the think-tank to be as objectively independent on government health policy as it claims to be. This is only reinforced by the appointment of Professor Chris Ham, another former DoH advisor as its new CEO. 

In addition, a number of Senior Associates and Expert Group members of the King’s Fund have also had key roles in developing the very government policies, which the King’s Fund is independently critiquing (for example, Mark Britnell, Paul Corrigan and Anna Dixon).

It’s time to recognise that the King’s Fund has a significant proportion of former DoH advisors, and people with commercial interests that could benefit from pro-market NHS reforms, helping to guide its work.

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