Editor’s blog Monday 28 June 2010: Post-Confed catch-up - Health Select Committee members; cancer outcomes; competition works; a

Good morning. As we re-enter daily reality (or what passes for it) post-Confed, having come home to gardens looking more savannah than suburbia,  we will wash up a few bits from the conference shortly.

For now, four quickish things: the FT’s Westminster blog announced the Labour and Conservative nominees for membership of the new Health Select Committee.

The select committee is genuinely important as a means of scrutiny, and the labour benches will be represented by Rosie Cooper, Fiona Mactaggart, Grahame Morris and Valerie Vaz.

The Conservative voice, under Tory chair and ex-Health Secretary Stephen Dorrell, will comprise Nadine Dorries, Chris Skidmore, David Tredennick and Sarah Wollaston (the GP selected by PM Cameron’s ‘open primaries’ system).

Two of the Tory nominees, Dorries and Tredinnick, provoked this magnificent riposte in The Guardian from Martin Robbins.

Diversity of opinion and maverick thinking are, in general, a good thing – they avoid ‘groupthink’ tendencies. There is, however, a reasonable cut-off point.

Both Tredinnick, and more particularly Dorries - of whom Robbins approvingly quotes Dawn Primarolo’s Parliamentarily scrupulous language, “The hon. Lady has asserted many things to be facts that are not” - seem to be well beyond that point.

They may add to the gaiety of health policy discussion, but their added value to the work of scrutinising government health policy and practice appears set to be slight.

UPDATE: Dorries is now openly contradicting her party's policy on protecting NHS funding.

Tory adviser – patient choice based on inadequate outcome data
Professor David Kerr, who advises the Conservatives on health policy, has told The Guardian’s Sarah Boseley that doctors in the NHS must collect and publish individual based, team-recorded and clinician-validated outcome data from their treatments. Kerr suggests that his own specialty of oncology cannot provide such evidence other than at population level, making meaningful choice for patients difficult.

Yes, that sound you’re hearing is Alan Maynard cackling.

Competition rules
Meanwhile, Zack Cooper and colleagues at LSE Health have published another working paper showing that competition within fixed-price markets in the hospital sector of the English NHS appears to be related to comparatively positive treatment results.


Does Hospital Competition Improve Efficiency? An Analysis of the Recent Market-Based Reforms to the English NHS suggests that “In more competitive markets, hospitals shortened their pre-surgery length of stay, but did not shorten their post-surgery length of stay. In sum, they became more efficient without compromising patient outcomes”.

DH flies high with personal budget pilots
Generally, if this site writes about the DH, any cheers are from the Bronx neighbourhood.

In the interests of slight unpredictability, it is therefore a pleasure to welcome the DH’s “>new announcement that direct payments of personal budget pilots are to be taken forward in eight of the 70 participating PCTs, listed below, with the DH explanation of personal budgets.

Personal budgets are no panacea. With direct payments, they present a microcosm of the financial governance issues facing GP commissioning, revealed last week.They are, however, thoroughly worth trying. And it is good to see that two of the bids are joint approaches – which may generate useful learning about how collaboration across systems functions with this innovation.

Doncaster PCT: Continuing healthcare and mental health
Eastern and Coastal Kent PCT: Continuing healthcare, end-of-life care, maternity, and mental health
Central London (joint bid from Hammersmith and Fulham PCT, Kensington and Chelsea PCT and Westminster PCT): Continuing healthcare, chronic obstructive pulmonary disease, dementia, diabetes, and mental health
Islington PCT: Continuing healthcare (in limited circumstances, with expansion subject to further approval)
Merseyside (Joint bid from Knowsley PCT, Liverpool PCT and Sefton PCT): Mental health
Oxford PCT: Continuing healthcare and end–of-life care
Somerset PCT: Children in transition to adult services, learning disabilities, long-term neurological conditions
West Sussex PCT: Carers of people who have recently been diagnosed with dementia, children in transition to adult services, continuing healthcare

These pilots will run until 2012.

A personal health budget involves:
An individual knowing how much money they can spend on their health care (their budget) before discussing and deciding what care and services they want.
The PCT and the individual agreeing a care plan which sets out:
- what the individual’s health needs and desired outcomes are;
- the amount of money in their budget;
- how this money will be spent to meet the individuals needs/outcomes.
Regular review of the care plan (at least once a year), and monitoring of how the money is spent.The money should meet the full cost of the agreed care plan.