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June 9, 2010

Welsh Institue of Health and Social Care Blog
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» Across the border

The horizon looks set for interesting times in the English NHS. The coalition agreement Our Programme for Government has no less than 30 pledges on the NHS and 4 for Public Health. Additional policy messages are also coming thick and fast, including promises this week to get tough on emergency readmissions.

There are already immediately tangible signs of the new broom. The proposed reconfiguration of services in London has been halted, all major DoH capital spending commitments have been called in for review and there’s confirmation that SHA’s will be gone by 2012.

Other themes have emerged. Patients must be “at the heart of everything we do”; this includes greater engagement in service redesign, directly elected representatives on PCT Boards, ability to choose your GP and hints at the possibility of patient-held budgets for long term conditions.

GPs are also coming back centre stage; given a pivotal voice on service reorganisation and a role as ‘patient’s expert guides’ through the healthcare system. The phrase ‘GP commissioner’ abounds, but more details on what this means in practice (particularly in relation to hard budgets) are still awaited. We’re no longer talking the language of targets, but outcomes and national quality measures will be the new performance barometer. Watch this space for more on these, we’re told. The customary messages about reduced bureaucracy are there, with promises of no more top-down re-organisation, but the responsibility for appointing PCT CEs now lies not with PCTs themselves, but with the SoS, advised by a new independent NHS Board.

There’s much more, but already questions are begged; what’s the detail of GP commissioning ? With any changed commissioning landscape (and no SHAs), what’s the accountability structure ? How can we deliver difficult service reshaping, increased efficiency and savings as well as effective engagement and achieving public and clinical support ? It promises to keep us all exercised and invigorated.

Written by Dr Paul Worthington

» Across the border

The horizon looks set for interesting times in the English NHS. The coalition agreement Our Programme for Government has no less than 30 pledges on the NHS and 4 for Public Health. Additional policy messages are also coming thick and fast, including promises this week to get tough on emergency readmissions.

There are already immediately tangible signs of the new broom. The proposed reconfiguration of services in London has been halted, all major DoH capital spending commitments have been called in for review and there’s confirmation that SHA’s will be gone by 2012.

Other themes have emerged. Patients must be “at the heart of everything we do”; this includes greater engagement in service redesign, directly elected representatives on PCT Boards, ability to choose your GP and hints at the possibility of patient-held budgets for long term conditions.

GPs are also coming back centre stage; given a pivotal voice on service reorganisation and a role as ‘patient’s expert guides’ through the healthcare system. The phrase ‘GP commissioner’ abounds, but more details on what this means in practice (particularly in relation to hard budgets) are still awaited. We’re no longer talking the language of targets, but outcomes and national quality measures will be the new performance barometer. Watch this space for more on these, we’re told. The customary messages about reduced bureaucracy are there, with promises of no more top-down re-organisation, but the responsibility for appointing PCT CEs now lies not with PCTs themselves, but with the SoS, advised by a new independent NHS Board.

There’s much more, but already questions are begged; what’s the detail of GP commissioning ? With any changed commissioning landscape (and no SHAs), what’s the accountability structure ? How can we deliver difficult service reshaping, increased efficiency and savings as well as effective engagement and achieving public and clinical support ? It promises to keep us all exercised and invigorated.

Written by Dr Paul Worthington

April 26, 2010

Welsh Institue of Health and Social Care Blog
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is about »
» Is England a Foreign Country?

The parties’ general election manifestos show just how different health policy in England has become from that in Wales.

The manifestos, of course, are talking about the English NHS. Superficially, England and Wales seem to share some objectives, such as improved access to care, protecting investment in the NHS, and spending money wisely. But the latest eye-catching ideas from England seem to have little to do with Wales.

The three main parties all agree on the key issue for England – how to drive up the performance of the NHS. Their shared recipe has three ingredients: help NHS workers take over and run their own services; encourage a range of provision; and give people lots more information on how well local services are performing.

This is as far from the debate in Wales as would be discussion about the merits of SATs in schools, or the transport infrastructure around the Olympic stadium.

Our ingredients for driving up performance include getting the public sector to work together, encouraging clinical networks and benchmarking, and a strong steer from the centre.

Contrast this with English Labour, where all the talk now is of getting good performers to take over the poorer ones, enshrining patient rights in legislation, and making primary care available from “8 ‘til late”.

The difference is startling, as is the consensus amongst the main parties in England.

None of this difference need matter, of course, and actually it might be a good thing to experiment with different approaches and see which works best. A moment of quiet reflection, however, might reveal a paradox: how can we be proposing two so completely different approaches to improving the NHS – to achieving essentially the same goals? One might wonder whether anyone actually knows which approach is best, or whether we are not all going with our gut instincts and the herd?

Surely not.

Written by Professor Marcus Longley, Director, WIHSC