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Editor’s blog Thursday 27 May 2010: The baker's double-dozen: 26 policy questions for Health Secretary Andrew Lansley

With acknowldgement to HSJ editor Alastair McLellan for the inspiration (i.e. I nicked his concept), here are a list of what I currently think are the top 26 health policy questions for Secretary of State For Health Andrew Lansley CBE MP.

1. Will GP commissioners or consortia have hard budgets?

2. If you are serious about GP-led commissioning, GPs will be at the sharp end of local rationing decisions. What evidence do you have that GPs want to do this?

3. GP commissioning will vary in quality, as PCT commissioning does. Relative commissioning efficiency will lead to a ‘postcode lottery’. Will you consistently support the right of the best commissioners to provide more and better care for their populations?

4. GPs might need incentives to become engaged in commissioning; these have usually been financial. Will this be your policy?

5. If GP commissioning incentives are financial, what proportion can be reinvested and what amount taken as profit?

6. What will you do about the one-third of GPs who DH surveys show consistently oppose the policy of practice-based commissioning?

7. Will GP commissioners and PCT commissioners be allowed to vary from the guidelines of the independent NHS commissioning board?

8. Does your creation of a national cancer drugs fund imply that you think NICE’s judgments on cancer drugs are wrong?

9. If so, why keep NICE?

10. Will your proposed social enterprise-type, employee-owned foundation trusts be responsible for NHS capital assets; able to keep profits; and liable for losses?

11. What will happen when such organisations fail?

12. Why do you want every NHS provider to become a foundation trust, when 12 of the 22 trusts registered with conditions by the CQC were FTs?

13. Given your emphasis on choice and competition as important policy drivers, what is your view on recent NHS vertical integrations, with acute trusts providing community and primary care?

14. Meaningful patient choice and information about quality and outcomes require better IT than the NHS currently has. Will you redefine the national programme as a set of interoperability standards, and let trusts choose providers?

15. PFI – now on the books as part of government borrowing - is a very expensive way to borrow, which does not genuinely transfer risks to the private sector (but does at least prevent scrimping on cleaning and maintenance). Will you review the value-for-money of existing deals and consider some form of refinancing?

16. Will you imitate previous subsidies - such as those under the ISTC programme - to increase independent sector involvement in commissioning and provision?

17. Will all NHS-funded financial arrangements with private sector providers and consultants be made open, and not covered under a ‘commercial in confidence’ defence from public scrutiny?

18. Will PCT and GP commissioners who do not wish to use independent sector provision and commissioning / management support be allowed to do so?

19. Why is abolishing SHAs not a top-down reorganisation of the NHS?

20. Where will SHAs’ functions in workforce planning and training and holding surpluses sit from April 2012?

21. Given that you wrote to ex-NHS London chair Richard Sykes that their interim, pre-abolition function is "supporting the decisions made in each area across London", in what way are SHAs strategic?

22. How much medical unemployment are you willing to tolerate?

23. Will you publish the salaries of all DH, NHS and health quango staff earning more than the Secretary Of State For Health’s ministerial salary of £142,500?

24. In what circumstances should you be able to over-rule the independent NHS commissioning board?

25. Who will be able to sack PCT chief executives – the PCT board with its newly-elected members, or the Secretary of State / CE of NHS Commissioning Board?

26. Who will be able to sack the chief executive of the independent NHS commissioning board?