New NHS CEO appointment raises questions about commitment to reform
The only public sector candidate to be shortlisted for the post of National Health Service chief executive got the job yesterday, prompting speculation that the government is losing its nerve over the scale of reforms. David Nicholson, 50, head of the new London strategic health authority, saw off a shortlist of otherwise private sector candidates compiled after a worldwide search.
The list included John Rowe, executive chairman of Aetna, one of the largest US health insurers; Ken Kizer, former chief executive of the Veterans Administration, the largest tax-funded healthcare provider in the US; and Ian Smith, chief executive of General Healthcare, Britain's biggest private hospital group.
Mr Nicholson's appointment comes as doubts remain over the government's determination to push through what appears to be the prime minister's long-term goal of turning the NHS largely into a health-purchasing organisation.
Under such an arrangement, provision of services would be increasingly separated out into free-standing businesses, coming either from a much wider variety of foundation trusts; new forms of enterprise in which staff are encouraged to leave the NHS and contract their services back; or from the existing private and voluntary sectors. Some believe that could lead to a formal separation of the NHS from the Department of Health.
Niall Dickson, chief executive of the King's Fund health think-tank, said: "If they had gone for any of the US or private sector candidates that would have reinforced and made absolutely clear the direction of travel."
But analysts were divided over whether Mr Nicholson's appointment suggested any rowing back on the government's ambition. "It may not," said one senior figure from the UK private healthcare sector. "But it will give succour to the people who are against all this."
That comment came as Unison and the British Medical Association, vociferous critics of the government's involvement of the private sector in healthcare delivery and commissioning, welcomed the internal appointment. The BMA said Mr Nicholson understood the service's "ethos and values".
An occasionally slightly dishevelled and, on his own admission, "directly spoken" Yorkshireman, Mr Nicholson, will in September take over a business that by 2008 will have a £90bn turnover.
He has 25 years' experience in the NHS, helping close long-stay asylums in his early years before turning Doncaster hospital into an NHS Trust during the Conservative internal market reforms of the 1990s. He has since been a regional and strategic health authority chief executive in Trent and Birmingham and the Black Country.
He resisted the imposition of independent treatment centres in Birmingham, arguing the NHS locally had capacity and plans to meet waiting time targets, but he also commissioned work showing patients wanted more choice in the NHS.
He told the Health Service Journal recently he saw his job as "about the management of change, not about keeping the system running". He added: "I'm on the side of the angels - the patients and taxpayers - not the organisations" and that "we have to change things, not protect the status quo".
Chris Ham, a former head of strategy at the department and professor of health services management at Birmingham University, said Mr Nicholson would give the top of the NHS a "very strong operational focus". But he added: "If there is a longer-term plan clearly to separate the commissioning of care from the provider side there is no-one better among NHS managers to oversee that. I don't think this appointment points to any less radicalism."
Given the recent rows over the NHS involving the private sector in commissioning care, and ministers' desire to still charges of "privatisation" ahead of the Labour conference, department insiders said a US appointment would have been "just too provocative".
Others said Mr Nicholson "sees exactly where it is going" but had the advantage of providing continuity and an understanding that an outsider would struggle to acquire of what needs to be done within the NHS to achieve that.
Andrew Lansley, the Conservative health spokesman, said that he, like others, saw a "strong case" for appointing an outsider.
The appointment comes at the end of a fortnight in which the department has made clear the more market-like approach to buying care will be managed carefully by tight rules that will limit hospitals' ability to treat many more patients and charge their local primary care trust for the work.
Ministers have decided not to extend to critical care the use of "payment by results" - a payment for each case treated - to let the new system of money following the patient bed down better.
http://www.ft.com/cms/s/070bee7a-1dd5-11db-bf06-0000779e2340.html
The list included John Rowe, executive chairman of Aetna, one of the largest US health insurers; Ken Kizer, former chief executive of the Veterans Administration, the largest tax-funded healthcare provider in the US; and Ian Smith, chief executive of General Healthcare, Britain's biggest private hospital group.
Mr Nicholson's appointment comes as doubts remain over the government's determination to push through what appears to be the prime minister's long-term goal of turning the NHS largely into a health-purchasing organisation.
Under such an arrangement, provision of services would be increasingly separated out into free-standing businesses, coming either from a much wider variety of foundation trusts; new forms of enterprise in which staff are encouraged to leave the NHS and contract their services back; or from the existing private and voluntary sectors. Some believe that could lead to a formal separation of the NHS from the Department of Health.
Niall Dickson, chief executive of the King's Fund health think-tank, said: "If they had gone for any of the US or private sector candidates that would have reinforced and made absolutely clear the direction of travel."
But analysts were divided over whether Mr Nicholson's appointment suggested any rowing back on the government's ambition. "It may not," said one senior figure from the UK private healthcare sector. "But it will give succour to the people who are against all this."
That comment came as Unison and the British Medical Association, vociferous critics of the government's involvement of the private sector in healthcare delivery and commissioning, welcomed the internal appointment. The BMA said Mr Nicholson understood the service's "ethos and values".
An occasionally slightly dishevelled and, on his own admission, "directly spoken" Yorkshireman, Mr Nicholson, will in September take over a business that by 2008 will have a £90bn turnover.
He has 25 years' experience in the NHS, helping close long-stay asylums in his early years before turning Doncaster hospital into an NHS Trust during the Conservative internal market reforms of the 1990s. He has since been a regional and strategic health authority chief executive in Trent and Birmingham and the Black Country.
He resisted the imposition of independent treatment centres in Birmingham, arguing the NHS locally had capacity and plans to meet waiting time targets, but he also commissioned work showing patients wanted more choice in the NHS.
He told the Health Service Journal recently he saw his job as "about the management of change, not about keeping the system running". He added: "I'm on the side of the angels - the patients and taxpayers - not the organisations" and that "we have to change things, not protect the status quo".
Chris Ham, a former head of strategy at the department and professor of health services management at Birmingham University, said Mr Nicholson would give the top of the NHS a "very strong operational focus". But he added: "If there is a longer-term plan clearly to separate the commissioning of care from the provider side there is no-one better among NHS managers to oversee that. I don't think this appointment points to any less radicalism."
Given the recent rows over the NHS involving the private sector in commissioning care, and ministers' desire to still charges of "privatisation" ahead of the Labour conference, department insiders said a US appointment would have been "just too provocative".
Others said Mr Nicholson "sees exactly where it is going" but had the advantage of providing continuity and an understanding that an outsider would struggle to acquire of what needs to be done within the NHS to achieve that.
Andrew Lansley, the Conservative health spokesman, said that he, like others, saw a "strong case" for appointing an outsider.
The appointment comes at the end of a fortnight in which the department has made clear the more market-like approach to buying care will be managed carefully by tight rules that will limit hospitals' ability to treat many more patients and charge their local primary care trust for the work.
Ministers have decided not to extend to critical care the use of "payment by results" - a payment for each case treated - to let the new system of money following the patient bed down better.
http://www.ft.com/cms/s/070bee7a-1dd5-11db-bf06-0000779e2340.html
posted by Dr Search- Principal Consultant at the Search Clinic at
8:00 AM
0 Comments:
Post a Comment
<< Home