31 March 2010

Hooray for the Health Committee

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.

Hey ho.


Cockroach Catcher said...

Given that so many banks with its highly paid experts in management failed in a colossal way and the state had to take over, why not let the state keep control without using the business model that has obviously failed the very institutions that it is meant to work.

Obama's reform as he stated himself is health insurance reform. We could followed that route in order that good money is not creamed off.

Many private predators are after government money as in any recession, they are the best fall guys.

The Cockroach Catcher

No One said...

turn the NHS into a state backed insurance scheme

folk pay in according to ability to pay, as currently

folk get payouts according to need, as currently

but crucially patients get to take their payout to any health provider they dam well choose

and the state stops providing medical care providers, and lets the market provide the care

with a little extra payments to special areas such a very rural populations

there is no reason to pay crap top down management to provide crap top down direction to stalanist health care providers

let the patients have clarity of what the state backed healthcare policy covers and what it does not cover, let them see directly when there is no payout rather than hiding it behind "wait and see" approaches and other such bollocks trotted out as valid approaches in the barbaric NHS

force the medical industry to bend to the will of the people and not the other way around

the sooner the better for all of us

guthrie said...

Very interesting. Got any more sources of information on the inefficiencies of the internal market?
I place the odds of any of the 3 major parties opting to save 4 or 5 billion quid by the recomended actions at a billion to one.

Julie said...

Glory halleluiah, Dr G. You never know your luck, you might get a hung parliament with the SNP holding the balance. They're against the internal market and PFI as well..

Cockroach Catcher said...

Quoted you in my latest post.

The Cockroach Catcher