Tuesday 25 January 2011: Lansley responds to criticism of the Health and Social Care Bill

The other day, I published the text of shadow health secretary John Healey's first speech responding to the Health and Social Care Bill.

I did so whole and un-analysed because it's early days for Mr Healey; he wasn't an author of Labour's previous health policies and could reasonably get a grace period to formulate some of his own (with the help of his new health policy adviser Joe Farrington-Douglas, soon to be ex-of the NHS Confed). The speech is also about broad principles.

So in the interests of some balance, I decided that I should borrow the whole, unexpurgated text of GP's video clip of SOS Lansley's speech to yesterday's Monitor / UCL Partners conference, billed as a response to his critics. It appears without intervention.

Secretary of State for Health Andrew Lansley: “Imagining that there is some mysterious dark secret art associated with commissioning is I think to miss the point… most GP practices, and many of those who work alongside general practice, are already, in many ways, commissioning – they’re making the decisions that determine the shape of services in their area. They’re just not doing it alongside the people who are responsible for placing the contracts or negotiating the contracts or monitoring the contracts or monitoring the resources as they flow as a consequence of those clinical decisions

“So my point about bringing together those two things is absolutely critical. And bringing the management of resources and the management of critical care together means we are going to have to fuse (as Martin says) people in the NHS who are responsible for management and people in the NHS who are responsible for clinical care.

“It’ll be true in hospitals; it’ll be true in the community. general practice – doctors, nurses, other health professionals – should be thinking increasingly about how they can combine their responsibilities and make sure that the management fo resources matches the way they want to design care for patients.

"The same way that I know in foundation trusts and many NHS trusts people are already looking at things like service line reporting – saying ‘how can we give those people who are responsible for the care of patients a much stronger sense of the resources they receive and will receive and the way in which we use them in order to improve the service that they deliver?’

“There’s nothing strange about this. But I do think that one of the things I find most depressing is the idea that somehow, the reforms are designed to fragment services. On the contrary. What we have to do is to enable the service to be more integrated in the future than it’s been in the past.

“It’s true of UCL Partners – an academic health sciences partnership –it’s looking beyond the walls and going extramural beyond the walls of hospital care, and I think that hospital trusts right across the country should increasingly be thinking of themselves not as hospital trusts but as healthcare trusts, and thinking about healthcare provision in a more integrated and networked fashion. And there’s nothing in our reforms that will stop that happening – and many things that should start that happening.

“Because when you start to design services from a clinical point of view, in order to drive improvement in outcomes, very often it’s the relationship between clinicians in the community and clinicians in hospital that best make that happen.

“And I remember that when the National Primary Care Centre looked at ‘care closer to home’ pilots, to see what best met the combined objectives of quality and access, it was actually the relationship between general practice and hospital specialist that was most likely to make that happen.

“We just need to make sure that some of the systems, not least the tariff system, through the introduction of things like year-of-care pathways and year-of-care budgets and care bundle tariffs enable those who commission to commission the services they want; enables the public as patients or care users to get the more integrated service that they want.

“Now I think once you’ve done all those things, from the clinical point of view, then leadership comes naturally to the fore because people who are clinical leaders are working within what they would regard as  their sphere of greatest experience and expertise – and putting management alongside them to make it happen”.