2006- the NHS's year for living dangerously- an FT editorial viewpoint
According to the Financial Times's editorial today- for the Labour government's healthcare policy, and possibly for the National Health Service in England itself, 2006 looks like a make or break year. Twelve months ago, the same would not have been said.
For 2005 appeared to start pretty swimmingly. Waiting times were falling, clinical results were improving, facilities were much better and there were new contracts for consultants and family doctors. The biggest pay reorganisation of them al - known as Agenda for Change - was
proceeding steadily, if a little late.
Then in July some uncomfortable facts emerged. It was confirmed that after six years of record real terms growth, the NHS had overspent. Not by much in the big picture of things, but the net £250m overspend in England presaged worse to come. The service is currently projecting a deficit close to three times that and the health department is planning on the assumption that 2006 will be at least as bad as 2005.
This truly shameful loss of financial control has created famine amid a feast. Patients in some parts of the country are made to wait longer for treatment. Clinics are closed to balance the books - although in practice still fail to do so.
With that came a botched step on the path to reform. Again in July, ministers ill advisedly agreed to the shotgun merger of primary care trusts and strategic health authorities when these were in practice starting to happen organically anyway.
On top of that, the service's top management told more than 200,000 staff in primary care trusts that while it could not tell them whether they would shortly be employed by the private sector, by general practitioners, by themselves, by a local authority, by some new "social entrepreneur" or by some new part of the NHS, the one thing about which they could be certain was that their future employer would not be their current one.
The result of these twin moves has been instability and uncertainty, with huge numbers of health service staff worrying about their next job rather than getting on with their current one.
Added to that, huge sums - 35 per cent of all the growth money on the department's figures, more according to most people's suspicions - has disapeared into extra pay with far too little to show for it in terms of modernised work practices or extra productivity.
None of this is to say that the NHS is not getting better. It is. But it needs to show far more improvement by 2008 when current record rates of spending growth will moderate. The reorganisation feels too much like rearranging the deckchairs on the Titanic.
The challenges for 2006 are large. Financial control must be re- established. A new regulatory system is needed to oversee the emerging market for suppliers, along with a new failure regime to cope with its inevitable consequences. Providers from the independent sector need reassurance - by deeds, not just words - that the government genuinely sees them as long-term partners in the market.
Chief executives need a change of mindset that drives them to save to invest rather than overspend. They must then use that approach to achieve the productivity gains so badly needed if the government is to stand a chance of getting the maximum wait from GP to an operation down to 18 weeks by 2008.
And, as patient choice and payment by results kick in, ministers and the department need not just to hold their nerve, but to drive ahead with reform as some services close and others open.
There is no guarantee that the government's current strategy will work. It contains paradoxes - a requirement for co-operation among healthcare providers along with a demand for competition.
But the recent experience of Scotland, Wales and Northern Ireland - where just as much extra money has been invested for even less apparent result - shows that just pouring new wine (more money) into old bottles (an unreformed service) does not work.
The current reforms may not succeed. What is certain is that tried half-heartedly they will fail. So they need to be seen through, with lessons learnt and adaptations made on the way. It is the year for living dangerously in the NHS.
http://news.ft.com/cms/s/3b76fa2e-79a2-11da-8d99-0000779e2340.html
For 2005 appeared to start pretty swimmingly. Waiting times were falling, clinical results were improving, facilities were much better and there were new contracts for consultants and family doctors. The biggest pay reorganisation of them al - known as Agenda for Change - was
proceeding steadily, if a little late.
Then in July some uncomfortable facts emerged. It was confirmed that after six years of record real terms growth, the NHS had overspent. Not by much in the big picture of things, but the net £250m overspend in England presaged worse to come. The service is currently projecting a deficit close to three times that and the health department is planning on the assumption that 2006 will be at least as bad as 2005.
This truly shameful loss of financial control has created famine amid a feast. Patients in some parts of the country are made to wait longer for treatment. Clinics are closed to balance the books - although in practice still fail to do so.
With that came a botched step on the path to reform. Again in July, ministers ill advisedly agreed to the shotgun merger of primary care trusts and strategic health authorities when these were in practice starting to happen organically anyway.
On top of that, the service's top management told more than 200,000 staff in primary care trusts that while it could not tell them whether they would shortly be employed by the private sector, by general practitioners, by themselves, by a local authority, by some new "social entrepreneur" or by some new part of the NHS, the one thing about which they could be certain was that their future employer would not be their current one.
The result of these twin moves has been instability and uncertainty, with huge numbers of health service staff worrying about their next job rather than getting on with their current one.
Added to that, huge sums - 35 per cent of all the growth money on the department's figures, more according to most people's suspicions - has disapeared into extra pay with far too little to show for it in terms of modernised work practices or extra productivity.
None of this is to say that the NHS is not getting better. It is. But it needs to show far more improvement by 2008 when current record rates of spending growth will moderate. The reorganisation feels too much like rearranging the deckchairs on the Titanic.
The challenges for 2006 are large. Financial control must be re- established. A new regulatory system is needed to oversee the emerging market for suppliers, along with a new failure regime to cope with its inevitable consequences. Providers from the independent sector need reassurance - by deeds, not just words - that the government genuinely sees them as long-term partners in the market.
Chief executives need a change of mindset that drives them to save to invest rather than overspend. They must then use that approach to achieve the productivity gains so badly needed if the government is to stand a chance of getting the maximum wait from GP to an operation down to 18 weeks by 2008.
And, as patient choice and payment by results kick in, ministers and the department need not just to hold their nerve, but to drive ahead with reform as some services close and others open.
There is no guarantee that the government's current strategy will work. It contains paradoxes - a requirement for co-operation among healthcare providers along with a demand for competition.
But the recent experience of Scotland, Wales and Northern Ireland - where just as much extra money has been invested for even less apparent result - shows that just pouring new wine (more money) into old bottles (an unreformed service) does not work.
The current reforms may not succeed. What is certain is that tried half-heartedly they will fail. So they need to be seen through, with lessons learnt and adaptations made on the way. It is the year for living dangerously in the NHS.
http://news.ft.com/cms/s/3b76fa2e-79a2-11da-8d99-0000779e2340.html
posted by Dr Search- Principal Consultant at the Search Clinic at
9:20 AM
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