Editorial Thursday 24 November 2011: NHS Operating Framework 2012-13

The NHS Operating Framework 2012-13 is available here.


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Click here for details of 'Flora Stalinism, leadership as partnership and loving the evil bastard. OF! There’s a nasty little sting in the Annex, too …', the new issue of subscription-based Health Policy Intelligence.

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The CCG annual management cost allowance will be £25 per unweighted head of population "before any entitlement to a quality premium" (no detail on which is offered), and the NHS Alliance/NAPC discussion document formula of viability beginning at 100,000 population is being accepted. The OF adds that “as far as possible CCGs should be coterminous with a single local health and wellbeing board”, reinforcing the presumption against crossing local authority boundaries.

A few quick thoughts (further analysis is to follow):

1. In the live streaming of presentations at the CEs' conference, Comdare Sir David Nicholson made much mention of the "spread" of good practice. The word 'Stalinism' is henceforth to be substituted by the word 'spread'.

2. In the OF appendix, Labour policy adviser Joe Farrington-Douglas points out that there is a new target to increase the "Trend in value/volume of patients being treated at non-NHS hospitals": see the table on page 49.

There is a slight problem, because the Government's response to the NHS Future Forum promised that "we will outlaw any policy to increase or maintain the market share of any particular sector of provider. This will prevent current or future Ministers, the NHS Commissioning Board or Monitor from having a deliberate policy of encouraging the growth of the private sector over existing state providers – or vice versa.".

Moreover, it contradicts the Health Bill clause 20.13.O as to  the NHS Commissioning Board duty as respects variation in provision of health services: "The Board must not exercise its functions for the purpose of causing a variation in the proportion of services provided as part of the health service that is provided by persons of a particular description if that description is by reference to — (a) whether the persons in question are in the public or (as the case may be) private sector, or (b) some other aspect of their status." (page 19).

It also contradicts the Bill as to patient choice and the NHS Commissioning Board: "The Board must, in the exercise of its unctions, act with a view to enabling patients to make choices with respect to aspects of health services provided to them" (page 18).

I mean, you wouldn't want a DH policy target that was going to involve breaking the law. Would you?

3. Commissioning support must be "commercially viable, customer focused and develop distinctly" from PCT clusters in 2012-13. This is very curious. And very un-defined. PCT staff will feel wonderfully reassured.