The public's opinion of MPs is at an all time low. It is all to do with moats and duck houses, bell towers and bath plugs. But they are not all bad. Fairly ordinary jobbing MPs on select committees seem to do quite a good job and quite often get at fundamental truths which seem to escape those in government.
The latest report of the Health Committee will not exactly be an eye-opener to readers of this blog but it does lend some credibility to the views of Dr Grumble and like-minded folk. At times it seems that nobody else is aware of these home truths about our health service to the extent that, just occasionally, Dr Grumble begins to just wonder if it might be him that is mad and not the rest of the world. So it was with some relief that Grumble read the latest Health Committee report on commissioning.
Dr Grumble has strong views on commissioning. He thinks that the quality of commissioning is poor and that PCTs are full of lower calibre, highly paid individuals who are just not up to the job. He thinks that the purchaser-provider market system must cost a lot to run (though Grumble has no idea quite how much) and that while the system might have some benefits these are greatly outweighed by the costs. In essence Dr Grumble takes the view that we used to have efficient process but we now have an extremely inefficient pseudo-market which is a yoke around the neck of a health service that now desperately needs to make painless savings. If, after 20 years, successive governments have not been able to tweak the system to make it work, now surely is the time to abolish the purchaser-provider split and save the NHS some money, perhaps a lot of money, in the process.
The report is over 70 pages long. Read the summary if you have time. It will tell you what you already know but you will feel good reading it. If you really haven't got the time, here are some words cut and pasted from the report and presented here as a few choice bullet points:
- The service has traditionally scored highly on account of its low cost of administration, which until the 1980s amounted to about 5% of health-service expenditure.
- After 1981 administrative costs soared; in 1997 they stood at about 12%.
- An estimate of administrative costs since 1997 has been made by a team at York University, in a study commissioned by the DH but never published. This concluded that management and administration salary costs represent, as a very crude approximation, around 23% of NHS staff costs.
- We are dismayed that the Department has not provided us with clear and consistent data on transaction costs.
- The suspicion must remain that the DH does not want the full story to be revealed.
- We were appalled that four of the most senior civil servants in the Department of Health were unable to give us accurate figures for staffing levels and costs dedicated to commissioning and billing in PCTs and provider NHS trusts.
- After 20 years of the purchaser/provider split commissioning remains a weak link in the English NHS. PCTs are too often passive, ineffectual players in the health economy.
- These weaknesses are partly due to structural imbalances in the system, but also to PCTs’ staffs’ lack of skills, knowledge and talent.
- The current health system with the purchaser/provider split is expensive to run with high administrative and management costs.
- The abolition of PCTs would generate significant financial savings in a period of considerable financial pressure.
And the last line in the Way Forward reads as follows:
- If reliable figures for the costs of commissioning prove that it is uneconomic and if it does not begin to improve soon, after 20 years of costly failure, the purchaser/provider split may need to be abolished.