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Editor's blog Thursday 10 September 2009: US healthcare reform bill; much ado about McKinseys and the steady hand of the Bill

Hello. I’ve been away finishing up a stint editing a journal about continence. Insert your own joke here.

I’m also just getting over a quick bout of something-or-other, so this will be very concise.

HPI associate director Tom Smith has written a useful piece on the Obama speech to Congress on healthcare reform. Contrary to many pundits' predictions, the US President wants the public plan option to be left in the bill. The maths on the voting for this bill are going to be extremely tight indeed.

Obama gave good speech, as he does. Perhaps the key question is why he left it so long to lead the case for reform, when momentum started building behind the more hogwhimperingly ludicrous fantasies being peddled by various strands of the American Right.

Meanwhile, much of the media seems to have got unduly agitated about Sally Gainsbury’s admittedly very nice story in HSJ on the McKinsey report into saving £20 billion meaning the loss of over 100,000 jobs.

It has been obvious to anyone with a brain (and repeatedly a feature of the content of this website) that the recession is going to impact on the money available to the NHS. The spending growth should not have come to appear the norm. NHS managers of any vintage, who knew the austerity of the 1970s and 1980s, have a better perspective of the likely course of events. Depressingly, few of them are still working in the NHS.

Job cuts on that kind of scale remain poor public policymaking. The NHS is not perfectly efficient, but the changes over the next decade, involving greater use of information and benchmarking (and yes, the much-maligned commissioning) and the transfer of more care to community settings, will require a significant workforce to deliver them.

Changing the way the NHS works is not an option when staring down the barrel of lousy national finances for probably a decade. Nelson’s telescope has been deployed to keep watch on variations in performance, activity and outcomes of care for too long.

Not watching the Monitor
Perversely, contrastingly little attention was paid to monitor executive chair Bill Moyes’ valedictory speech to the Foundation Trust Network conference in Birmingham (Moyes leaves Monitor in January 2010).

Moyes outlined to delegates the need for “really tough operational change: higher staff productivity that releases cash; better procurement and supply chain management; and better investment decisions, especially in information systems.

“Similarly, commissioners will be focusing on procuring the most cost-effective care pathway, increasingly using NICE specifications. They will be examining referral and admission rates and challenging providers whose conversion rates are consistently high. And they will be working hard to prevent referrals to hospitals for treatments of no benefit”.

He is quite right about all of these. Moyes has been awkwardly independent – always a good thing, and by extension, he has given the independence of FTs real credibility. He choice of his successor will be a decisive one.

Moyes also warned of “a different sort of political challenge, which could strike at the very heart of the foundation trust policy. It comes not primarily from Ministers but from Parliament, and to a lesser extent from the public and the media”. Once again, he hits the nail on the head.

Read the whole speech: it is one of the more thoughtful contributions to public policy for some time.