Last brick in the wall for the new look NHS health insurance
The decision by the Department of Health to open up the purchasing of NHS care, as well as its provision, to the private sector amounts to the last brick in the wall in the government's construction of the new-look health service.
To patients, such a move will make no immediate difference. They will still visit their GP and, if need be, move on for treatment, still free at the point of use, to the hospital or community services that are paid for by their primary care trust.
Already these services can be provided by a traditional NHS trust, by the new free-standing Foundation Trusts or by private and not-for-profit providers.
The difference is that it would not be NHS staff, directly employed by a PCT, who would be choosing which services - including GP services - provide the best available choice. That would be undertaken by a privately-owned manager, operating on contract to the PCT's board and charged with obtaining the best value for money.
The move is part of what the health department calls a "step change" that is shifting the NHS from being "a services provider to a commissioning-led organisation" - one that operates in effect as a giant, tax-funded health insurance scheme with no ideological view remaining about who should provide the service: the publicly- owned NHS, the private sector, or the third sector made up of voluntary organisations and charities.
To opponents, this will be seen as another big step towards "privatising" the NHS even though care will remain, as now, largely free at the point of use.
The move reflects the fact that "ministers do not have huge confidence that the NHS itself can deliver what is required on commissioning", Chris Ham, professor of health services management at Birmingham University, said yesterday.
"The question," Prof Ham said, "is how confident you can be that if you bring in external expertise, is it going to do any better?"
Such expertise tends to lie with health insurers. But he said: "UK health insurers have expertise in a fairly narrow range of services, chiefly elective care and diagnostics, that make up a tiny proportion of what the NHS provides."
"The big US insurers have expertise across the full range of services. But they are not used to operating within the fixed budgets and political constraints on health care in the UK." German and Dutch sickness funds, which come closer to a direct parallel with NHS commissioning, would also face cultural difficulties.
Commissioning has always been the Achilles heel of the attempts by both Labour and the Conservatives to use market mechanisms to improve NHS care.
Given that the department is advertising only a "framework" agreement, "it remains possible that this will not be implemented", Prof Ham said.
"Nonetheless, if you are looking for ways to help PCTs improve their performance, this may be a smart way to do it."
http://www.ft.com/cms/s/19cf82d8-ff30-11da-84f3-0000779e2340.html
Bringing in the insurance companies at the same time as refocusing the NHS purely as a services funder is crossing the final Rubicon.
To patients, such a move will make no immediate difference. They will still visit their GP and, if need be, move on for treatment, still free at the point of use, to the hospital or community services that are paid for by their primary care trust.
Already these services can be provided by a traditional NHS trust, by the new free-standing Foundation Trusts or by private and not-for-profit providers.
The difference is that it would not be NHS staff, directly employed by a PCT, who would be choosing which services - including GP services - provide the best available choice. That would be undertaken by a privately-owned manager, operating on contract to the PCT's board and charged with obtaining the best value for money.
The move is part of what the health department calls a "step change" that is shifting the NHS from being "a services provider to a commissioning-led organisation" - one that operates in effect as a giant, tax-funded health insurance scheme with no ideological view remaining about who should provide the service: the publicly- owned NHS, the private sector, or the third sector made up of voluntary organisations and charities.
To opponents, this will be seen as another big step towards "privatising" the NHS even though care will remain, as now, largely free at the point of use.
The move reflects the fact that "ministers do not have huge confidence that the NHS itself can deliver what is required on commissioning", Chris Ham, professor of health services management at Birmingham University, said yesterday.
"The question," Prof Ham said, "is how confident you can be that if you bring in external expertise, is it going to do any better?"
Such expertise tends to lie with health insurers. But he said: "UK health insurers have expertise in a fairly narrow range of services, chiefly elective care and diagnostics, that make up a tiny proportion of what the NHS provides."
"The big US insurers have expertise across the full range of services. But they are not used to operating within the fixed budgets and political constraints on health care in the UK." German and Dutch sickness funds, which come closer to a direct parallel with NHS commissioning, would also face cultural difficulties.
Commissioning has always been the Achilles heel of the attempts by both Labour and the Conservatives to use market mechanisms to improve NHS care.
Given that the department is advertising only a "framework" agreement, "it remains possible that this will not be implemented", Prof Ham said.
"Nonetheless, if you are looking for ways to help PCTs improve their performance, this may be a smart way to do it."
http://www.ft.com/cms/s/19cf82d8-ff30-11da-84f3-0000779e2340.html
Bringing in the insurance companies at the same time as refocusing the NHS purely as a services funder is crossing the final Rubicon.
By admitting to what is in effect the Labour creation of the NHS health insurance company, Tony Bliar is admitting his failure as Tony Bliar admits his NHS failure that the billions of Pounds that he poured into the NHS have not made it the world class service he promised. He reveals that where people live still affects the kind of treatment they get.
posted by Dr Search- Principal Consultant at the Search Clinic at
10:50 AM
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