political commentator * author * publisher * bookseller * radio presenter * blogger * Conservative candidate * former lobbyist * Jack Russell owner * West Ham United fanatic * Email iain AT iaindale DOT com
Saturday, October 09, 2010
My Health Report for Policy Review TV
At the Conservative conference I spoke to various politicians about GP commissioning and whether it would work.
Interesting, except for your Kay Burley moment when you assert that GP commissioning was not in the Conservative manifesto. Oh yes it was: "We will strengthen the power of GPs...by giving them power to hold patients' budgets and commission care on their behalf" (p.46). The commitment was, not surprisingly, repeated and amplified in more detail in the separate health manifesto that the party published.
It is therefore a red herring that Andrew Lansley sprung this policy as a surprise in the white paper in July. Indeed, anyone who has followed health policy with even half an eye open will know that he has been talking about very little else for years and years.
The misunderstanding is, in fact, the result of some sharp practice on Lansley's part because it is also true that he pledged no more major upheavals to the NHS. Again, for anyone who knows anything about the NHS, it was possible to see all along that GP commissioning, if pursued with any kind of vigour, would lead to precisely that.
The only reason this hasn't come up before is because the media, with understandable wariness about venturing into such an anorak zone, never had the wit to pick it up.
I have to agree with HampsteadOwl. I have been blogging on Lansley's plans from the beginning of this year and nothing in the White paper surprises me.
The most important point came from Dominic Raab where he mentioned about "local democracy". This was the whole point of the plan for elected PCT boards in the Lib Dems manifesto and in the Coalition Agreement, which was soundly rejected by Lansley. Unfortunately, the GP consortia will give us LESS democracy than the Lib Dem plans, and LESS public accountability than PCTs. (Did you know that you can attend, and ask questions at your local PCT board meeting? I thought not, perhaps people would regard PCTs more if they knew that and went to some PCT meetings.)
Margot James did not have a clue. She said that there were too many PCTs but to make GP consortia more local that means that there has to be more of them! (Actually, to be more efficient there will have to bee fewer consortia than PCTs - 80 (ie half the number of PCTs) is being talked about.) As to James' assertion that PCTs are "too remote" that is the point of them! GPs want to be clinicians, they want to make clinical decisions, the remote PCT means that someone else has to make the financial decisions. GPs are rightly scared that with the NHS cuts that are coming through it is them (GPs) who will be applying them.
Will GP commissioning work? Yes it will, just like most of the changes to the NHS over the last few decades. The reason is not because the policy is necessarily right, it is because dedicated NHS personnel (and that includes managers) will make it work regardless. The alternative - of a failure in our healthcare system - is too horrible to contemplate.
However, Lansley must not use this as an excuse to cut deeply. The £850m that he intends to save in management is arbitrary - he's simply said that management will cost £1bn (rather than the current £1.85bn) without a clue how to achieve this. If Lansley wants GP commissioning to work he should get rid of stupid arbitrary cuts (45% in management, 30% in administration) and do what he says he wants to do and allow GPs to decide. He won't, of course.
3 comments:
Very interesting, health policy in this country I do find somewhat fascinating given our NHS and the public's love of it. Reform is always risky.
Iain,
Interesting, except for your Kay Burley moment when you assert that GP commissioning was not in the Conservative manifesto. Oh yes it was: "We will strengthen the power of GPs...by giving them power to hold patients' budgets and commission care on their behalf" (p.46). The commitment was, not surprisingly, repeated and amplified in more detail in the separate health manifesto that the party published.
It is therefore a red herring that Andrew Lansley sprung this policy as a surprise in the white paper in July. Indeed, anyone who has followed health policy with even half an eye open will know that he has been talking about very little else for years and years.
The misunderstanding is, in fact, the result of some sharp practice on Lansley's part because it is also true that he pledged no more major upheavals to the NHS. Again, for anyone who knows anything about the NHS, it was possible to see all along that GP commissioning, if pursued with any kind of vigour, would lead to precisely that.
The only reason this hasn't come up before is because the media, with understandable wariness about venturing into such an anorak zone, never had the wit to pick it up.
I have to agree with HampsteadOwl. I have been blogging on Lansley's plans from the beginning of this year and nothing in the White paper surprises me.
The most important point came from Dominic Raab where he mentioned about "local democracy". This was the whole point of the plan for elected PCT boards in the Lib Dems manifesto and in the Coalition Agreement, which was soundly rejected by Lansley. Unfortunately, the GP consortia will give us LESS democracy than the Lib Dem plans, and LESS public accountability than PCTs. (Did you know that you can attend, and ask questions at your local PCT board meeting? I thought not, perhaps people would regard PCTs more if they knew that and went to some PCT meetings.)
Margot James did not have a clue. She said that there were too many PCTs but to make GP consortia more local that means that there has to be more of them! (Actually, to be more efficient there will have to bee fewer consortia than PCTs - 80 (ie half the number of PCTs) is being talked about.) As to James' assertion that PCTs are "too remote" that is the point of them! GPs want to be clinicians, they want to make clinical decisions, the remote PCT means that someone else has to make the financial decisions. GPs are rightly scared that with the NHS cuts that are coming through it is them (GPs) who will be applying them.
Will GP commissioning work? Yes it will, just like most of the changes to the NHS over the last few decades. The reason is not because the policy is necessarily right, it is because dedicated NHS personnel (and that includes managers) will make it work regardless. The alternative - of a failure in our healthcare system - is too horrible to contemplate.
However, Lansley must not use this as an excuse to cut deeply. The £850m that he intends to save in management is arbitrary - he's simply said that management will cost £1bn (rather than the current £1.85bn) without a clue how to achieve this. If Lansley wants GP commissioning to work he should get rid of stupid arbitrary cuts (45% in management, 30% in administration) and do what he says he wants to do and allow GPs to decide. He won't, of course.
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