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Editor's blog 18 June 2008: NHS Confederation conference, day one

Andy Cowper, editor, Health Policy Insight
The Day Today: Wednesday 18 June 2008 - Day One NHS Confederation conference
And so to Manchester for the NHS Confederation conference, via Heathrow Terminal Five - not so much an airport, more a shopping opportunity. Blimey, what a decade you’ve just had if you love shopping. Now credit is crunchy and there’s a real risk of 70s-style stagflation, things look different.

It’s not as if there is any shortage of subject matter for this conference. The Confed has published a strong series of briefing papers on a range of topics – compassion in heathcare being perhaps the most potent. Polyclinics have dominated the news agenda with the sitzkrieg between the Government and the BMA-Conservative twin-pronged attack.

What do we expect from a Confed Conference? Apart from catching up with old friends and colleagues? Big-name speakers; a large exhibition, and the key debates to be addressed. Today Alan Johnson will re-announce the policy of measuring compassion and quality in nursing.

Measuring up

Measurement of things is not always popular, and indeed not always easy. We like it round here, though, because it helps force attention onto basic subjects that sadly, the system is capable of neglecting. Like hygiene. Like nutrition of elderly patients.

Two excellent pieces were published today on measurement, by Bernard Riberio of the Royal College of Surgeons - Outcome data must help health professionals as well as patients
and One small step on a complicated journey by Professor Alan Maynard , whose first column for this site will appear on Monday.

The potential downsides of measurement come when a) people turn it into a fetish and a proxy for activity; b) people game it (human nature, alas); and c) when the data is collected but nothing is done with it. All are real risks, but not even all three together amount to half a good reason not to pursue measurement.

The trick is to make measurement matter: get local ownership of the findings, and review them at appropriately regular intervals enough to enforce or embarrass action as a result.

Coherent policy

Journalists and editors are generally neophiliacs: we love what is new. New policies, or even reviews of old policies (see top-ups coverage yesterday), catch our magpie attention. It’s a bit like shopping – look a that shiny thing! Ooh!

Yet there is an argument that the NHS does not need one single new substantial policy announcement. Recent reports from the Healthcare Commission and Audit Commission argue that the refoms are not delivering for patients.

A new release from the Kings Fund, ‘Making It Happen’ by Alastair Liddell has found “all of the various elements of the reforms are working somewhere, although not always as intended. None is working everywhere.

Most importantly, there is still no clear understanding of the ‘rules of the game’ out in the NHS, or the strategies needed for ‘winning’, in response to a set of incentives designed to deliver continuous improvements in services for patients and the public”.

This is a serious problem, albeit not a new one. Continuity is obviously not desirable if it means continuity of the wrong thing. And without doubt, the narrative of the reforms has often been incoherent. That is another challenge for the Department of Health to consider, both in its policies and its communications. This is the same Department of Health rated as one of the three worst departments in government.

A constitution will not help this in any way, and could well hinder (unless it’s so vague as to be meaningless). But we will come back to that.

Monitoring FTs’ private income

Meanwhile, Monitor has launched its ‘Consultation on the interpretation and application of the private patient income cap’.  UNISON’s application process for a judicial review over the activities of some foundation trusts (FTs) in seeking to circumvent the cap on the percentage of private income mandated in the 2006 Act. The document resists easy summary, as it is a consultation document. You can find it here.

More to follow, Nye Bevan has just won the most important person in the history of the NHS vote.