Editor's blog Tuesday 2 November 2010: Interesting times in Parliament
Today was an interesting day in parliament. In the morning, the increasingly promising health select committee took its second evidence session on commissioning. In the afternoon, the new opposition health team had their first go at health questions.
What, then, did we learn?
From the commissioning evidence session, Dr Richard Vautrey of the BMA re-emphasised that the bulk of future commissioning will be done by "lay managers", criticising the poverty of central efforts to create clear messages for good managers in retention.
Responding to a question about the downbeat BBC and Kings Fund surveys of clinicians, NAPC's James Kingsland suggested that "managers and GPs understand very different things by word 'commissioning'".
Ex-RCGP president Steve Field said, "the problem with world-class commissioning was that there was no sense of urgency for change". NHS Alliance's Michael Sobanja added that the White Paper is about changes of culture and behaviour, not of structure - particularly for the DH and the new national commissioning board. Sobanja also dubbed the idea of national commissioning board responsibility for maternity services "bonkers", adding that the White Paper was "very short on detail about the national commissioning board".
Committee member MP Andrew George rather bizarrely said that the White Paper was being treated as a matter of government legislation, rather than a consultation. He seems to have been thinking about green papers.
A subsequent set of GPs offered a diversity of views. Dr Tomlinson suggested that the White Paper "will drive a bigger wedge between GPs and hospital colleagues". Peter Smith suggested that the GP-patient consultation is now too rushed and we're asked to do too much. To get a primary care-focused NHS, GPs have to become a lot more accurate in diagnosis and need more time with patients".
Asked if this meant a need for more GPs, Smith thought probably so, adding, "if we get our diagnosis right, that'll mean less tests, better diagnosis, and hopefully, the same or less use of secondary care"
Healey's first crack at Lansley
And so to the Commons chamber, with Labour's shadow health team taking their first crack at the Coalition team.
Labour's Emily Thornberry went on social care, quoting LGA figures on savings. Lansley did not accept her premise of a £2 bn shortfall ahead for social care
Specialised top-up funding for children's services were the principal line of attack from Tony Lloyd and Frank Dobson, prior to Healey's intervention. Lansley explained the changes to specialised top-ups as about changes to tariff and accuracy of costs.
Healey launched an assault based on the new House of Commons Library research report, which confirms that (in his words) "including the (social care) funding is critical to the description of the settlement as a ‘real terms increase’; without it, funding for the NHS falls by £500m – 0.54% in real terms”.
Lansley refuted this by calling Healey "wrong".
An interesting approach - the more so because the Commons Library report concludes that, "it is worth noting that the real terms percentage increases in the NHS settlement are so small that whether it amounts to an increase 'as is' hinges almost entirely on the accuracy of the OBR's GDP deflator forecasts: if these turn out to be even slightly higher than expected, the NHS will have to get more than the Spending Review amounts if the 'real terms increase' pledge is to be maintained. Moreover, the NHS experience of inflation will differ from the GDP deflator measure. John Appleby (chief economist at the King’s Fund) has suggested that NHS and economy-wide inflation may remain similar over the next couple of years but that by year 3, pressure to pay more may contribute to a higher rate of cost increase for the NHS".
Health Minister Simon Burns (whose voice increasingly reminds me of the talking Action Men of my childhood) told the Commons that GP consortia comissioning budgets will have to make accounts available to public: the independent commissioning board will consolidate consortia accounts into its national picture.
Asked by HSC member Rosie Cooper whether accountability should see councillors on GP consortia boards? Burns replied that their position on the local council, with its new heath role, is "the right venue for them". Burns was also on the sharp end of a jibe from Labour MP Barry Sheerman asking why his constituents should take health lectures from "a Minister who is out of condition, overweight and a chain smoker?".
Liberatin' Lansley found this very funny, for some reason.
HSC chair Stephen Dorrell asked Burns whether s consortia are established, ministers will ensure that they are subject to Monitor-style financial assurance: a job for the new NHS independent national commissioning board? Burns said the task was not the same as Monitor's but he thinks that "financial accountability for consortia is important".
Well, good! Burns argued in another reply about the abolition of cancer waiting diagnostic targets, "to say we abandoned a cancer target that didn;t exist is poppycock".
Lansley took repeated opportunities to emphasise the £1.9 billion annual saving on management costs that he anticipates by 2014-15; the strong implication being that management is a cost and a waste.
David Lammy asked Liberatin' Lansley why he now planned to neuter NICE. The Liberator replied that Lammy had got it "completely wrong. We are not neutralising NICE. On the contrary, we will focus NICE on what its real job always was and should be, which is to provide independent advice to the NHS about the relative clinical and cost-effectiveness of treatments so as to achieve the best outcomes. The point that he may be misunderstanding is that by 2014 we intend to ensure that we are no longer denying access to the new medicines that patients need, because we will have a new and more effective value-based pricing system of reimbursement to pharmaceutical companies".
A PFI question from Penny Mordaunt asked, "What can the Government do to assist the Queen Alexandra hospital in Portsmouth, which is under serious financial pressure because of its PFI contract, a £37 million deficit and, thanks to false planning assumptions, not enough patients to make a super-hospital sustainable?". The answer was it's working with the SHA. (Yes, the ones soon to be abolished.)
Former health minister Ben Bradshaw asks The Liberator "since when has handing over service to producer improved services, and will GPs really regulate themselves?. The Liberator replied that "if he is defending PCTs, he is making a bad move.
Thoughts in summary
1. Liberatin' Lansley is consistently determined that the best way to answer his critics is to tell them they are wrong. It's an interesting approach to note. Talking Action Man Burns somewhat emulates it, leaving Paul Burstow and Anne Milton actually answering the questions.
2. Labour need to be tighter and more focused in their questioning. They thought they were onto a winner with the specialised uplift tariffs for acute children's services - emotive.
3. A 'managers-equal-costs-and-waste-of money' mentality seems to be re-emerging among ministers. This is unhelpful to sensible policymaking.