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Editor’s blog Tuesday 1 March 2011: Commissioning inquiry; The Thunderer thunders; and the new health lottery

The Health Select Committee resumed its deliberations on commissioning this morning, hearing evidence from a partner in Beechcrofts, and health policy specialists Professor Calum Paton, Professor Paul Corrigan and NHS Confederation acting CE Nigel Edwards.

Chair Stephen Dorrell’s opening question was about the confusing evolution of commissioning policy in the light fo the Health Bill: is it centralising power, or dissolving the national in NHS?

Both the lawyer from Beechcrofts and Nigel Edwards agreed that it would depend on how the NHS Commissioning Board will behave. Edwards added a caution that outcome measures to assess success are embryonic in provision; and less formed still in terms of commissioning.

Paul Corrigan proposed that the Bill is centralising and liberating at the same time, due to the NHS’s intrinsically centralising and top-down culture.

Calum Paton characterised the Bill’s development of commissioning as akin to mending the boat while sailing in it, pointing out that the organisations which must create the new system (PCTs and SHAs) know they face abolition. He added that more Nicholson means more centralising tendencies (noting Nicholson’s doughty fighting with Monitor on behalf of internal regulation), and that the Bill is less policy than vision, with scant regard for effective implementation.

Edwards told the committee that the greatest potential in the reforms relies on GPs getting to grips with their colleagues’ performance and the relationship with secondary care. He pointed out that there will be more varied performance, wondering if there will be enough successes to offset the inevitable failures.

Corrigan added that the highest-spending outlier GPs will be those with whom it will prove most difficult to have conversations about performance.

Dorrell suggested that this makes quality maintenance into a political process; Corrigan’s rejoinder was that rather it makes it a managerial one.

Calum Paton pointed out that Nick Mays’ evaluation of total purchasing pilots found that the greatest successes were achieved around the amalgam of traditional and extended primary care services.

Rosie Cooper MP suggested that the dialogue around NHS reform as being akin to privatised and regulated utilities made it worth noting that privatised utilities led to high prices, huge profits for providers and far from exceptional services.

Nigel Edwards suggested that the Bill’s accountability proposals around moving the tail of quality look relatively weak.

Paton asked whether Monitor, as economic regulator, will sacrifice sensible integration arrangements of the altar of ‘there must be competition’. Edwards added that the Bill assumes the invisible hand of the market will shape everything, and assumes that there is no role for planning services.

Corrigan answered a question from Nadine Dorries MP on whether he supported the Bill’s mechanics enabling more centres of excellence, leading to better outcomes by saying absolutely – the Bill’s mechanism for making that happen is informed empowered patients, willing to shop around as they do for cars and other things. He also suggested that we've not been open with the public about what locality commissioning can deliver.

When Murdoch is against you …
The Times is not primarily known as a radical hotbed of anti-Conservative policy dissent. So its leader today has no slight significance. Health policy has tweaked the nose of mainstream attention.

Its leader states, “Ministers took a gigantic step between May, when the Coalition Agreement anticipated an evolution of existing institutions, and July when the Health White Paper heralded fundamental upheaval with the plan to abolish Strategic Health Authorities and create an internal market. There is still not convincing explanation of how this intellectual leap came about and what its merits are”.

A national health lottery
And finally … ”>The Independent today highlights proprietor and philanthropic pornographer Richard Desmond’s new national health lottery.

Just a shame that Our Saviour Lansley beat him to it.