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Editor’s blog Tuesday 23 March 2010: Ex-Audit Commission boss to Monitor; Moyes and Corrigan on NHS reform

Hello. This week may be more than a bit sketchy. You know what I mean, 'Arry?

Yes, you do.

Anyway. Steve Bundred, apparently.

Monitor’s new chair.

Who wrote this about financial cutbacks in The Times last February.

And this in The Observer last June.

And wrote this about board assurance for - um - the Audit Commission last April.

Beyond doubt an interesting choice.

Corrigan and Moyes on the future
Meanwhile, if you want to know what Bill Moyes and Paul Corrigan think we should be doing, you can find out here.

Their document for Policy Exchange think-tank, Future Foundations: towards a new culture in the NHS, questions the involvement on ministers in operational matters. Thus far, thus sensible.

It opposes centralisation, which is also a reasonable principle for reform.


It also suggests “the practical terms of experiencing NHS care there is no experience of cost to the public. And in terms of demand for more care and treatment, the money comes from somewhere else, so, of course we all want more”.

Which is doubtful.

People - us, we, you and me - experience their NHS care as citizens and taxpayers. There is a good point to be made about whether people should understand, in sovcially and culturally appropriate ways, what their treatment costs the system.

But the concept that indirect payment through a tax-funded system makes people want more is not at all clear.

It suggests five solutions essential to “creating the culture that is needed in Government to enable autonomy to flourish and with it creativity and innovation”. These are:
1. Developing real competition
2. Developing a pricing framework that drives change (through the tariff)
3. Foundation Trusts believing in and using the autonomy that they have
4. Regarding healthcare as an industry, not an organisation or a system (rather than DH regarding itself as the NHS HQ)
5. Developing real power of the payors

The last is probably the most interesting suggestion; that “neither the Department of Health nor the SHAs have created a risk-based national system of regulation for commissioning to match the regulatory framework within which Foundation Trusts operate. This is long overdue. Not only would it drive forward the development of commissioning, but it would begin the process of culture change that is so essential for the future of healthcare in England.

“Commissioning needs to develop into the local driving force of service improvement, challenging providers to be more efficient and effective and to meet the needs of patients in the most clinically- and cost-effective way”.

It’s all instinctively true-looking. Yet the fact is that sorting out National Hospital Service provision was the driver of the waiting time reforms. Payment reforms – tariff and PbR – came later.

Commissioning should have been separated from provision sooner, but maybe – given its immaturity as an industry - it was the commissioning function, rather than the community and primary care provision, that should have been hived off into new organisations.

And finally …
A&E waiting time targets produce perverse incentives shock.

Paul Krugman on US health reform.

GPs want to spend MORE time with (some of) their patients - unlike their recent desire to spend less time with them.