Wednesday 23 June 2010

NHS Costs

There's been much discussion on the blue/gold government's health policies. Rightly so. It's serious, it really really matters and it's possible to cock it up, spectacularly, if they get it wrong.

Some areas, such as qualified nursing staffing levels, have been poorly resourced in most in-patient and many community teams, for years. What will the new "austerity measures" mean? For our Trust we're already uneasy, with no uplift from any of our PCT commissioners this year, so we're having to do more with the same amount of cash (but inflation means we of course have less). And, of course, we're still obliged to make cost reduction efficiency savings each and every year, trimming off literally millions from what invariably are our staff costs.

Local and regional "stretch targets" mean we lose millions if we don't meet the quality targets (and evidence that we meet them). We won't. We can't meet some of them. Others, if we did meet them, it'd cost more to do that than we'd get paid. So we're destined to lose cash that historically has been part of our base income. Even less cash to pay our staff with. Not good.

Although it looks ugly in Secondary Care, in fairness it looks uglier elsewhere. My poor colleagues in Primary Care are being pushed into a corner. Instead of seeing patients and providing clinical care, they're going to be expected to commission services from providers. With the best will in the world, how could 30 consortia get different services from our Trust? Would providers tender for activity from a single practice if that GP practice wanted services that couldn't be easily provided? Will a Trust provide "loss leading" services? Our Trust has declined work from a PCT that's invited us to undertake activity, but won't pay us enough to consistently break even, so even with large amounts of cash from a PCT we're saying no; what influence will a group practice have? I do not know. But the GPs I know are not enthusiastic about having to sort out all this commissioning nonsense for all their patients for all clinical community and hospital and acute and mental health activities. At the moment, GPs are independent. Unlike a PCT, or SHA, they're not directly accountable to the Department of Health. If they commission quirky services, is there any accountablity? Not at the moment. Will GPs be brought into an accountability framework?

It doesn't look fun to be be sitting in GP land, right now.

The government quite rightly is looking at management costs within the NHS and thinks too much cash is spent on management. They're right. It is.

Slimming down Whitehall to do less and tell us to do less, such as disbanding oodles of targets, has to be a good thing.

Slimming down the regional Strategic Health Authorities (SHAs) seems a fair plan. Less intrusion and more cash saved.

Slimming down (or almost getting rid of) local Primary Care Trusts (PCTs) has left my PCT colleagues in a state of anxiety. Sadly, in all honesty, I'd not miss much of the PCT if they went. I'd miss the PCT pharmacists who are dynamic, sensible, pro-active, helpful and clinically focussed. But much of the managers and their committees and generated paperwork doesn't make quite as much impact on the district's health provision as some might imagine. Certainly the cash thrown at the buildings and staff and operation of the PCT doesn't seem to deliver wondrous value for money. But I concede I don't see all they do.

So the central DoH, the regional SHAs and local PCTs are all in the firing line. None of this seems bad, to me.

GPs are to have more duties, responsibilities (and accountability).
This does concern me, since most GPs I know aren't keen on this and aren't equipped to do this.

Secondary Care providers continue to provide secondary care.

Could have been a whole heap worse, dismantling front line services. But to be hitting the tiers of management actually is a positive intervention that can save money, reduce intrusion and improve how GPs and hospitals deliver care.

I remain optimistic.

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