Editor's blog Thursday 11 November 2010: Risk reserves and charity commissioning

Goodness gracious. For want of shorter, more anglo-saxon words.

Tom Ireland of Healthcare Republic reports that Liberatin' Andrew Lansley told a meeting of GPs in Halton that private sector or charity-led 'commissioning support organisations' will help GP consortia share financial risk.

Is there some bet on for who can deliver the most half-baked piece of policy in 2010?

One can only assume so - and this is an audacious, late-ish bid for victory.

Reportedly, Lansley told those present that organisations formed from either charities, PCT staff or the independent sector would help consortia across England design services and "offer to take on the risk" of the associated costs.

"You can say to a commissioning support organisation here is the standard we are looking for, we want you to put a commissioning framework in place, and you can take on that risk. I think you will see lots of organisations from charities, the voluntary sector or people currently working in PCTs - and these organisations will start to offer to take on these risk".

A governance and insurance nightmare lies ahead. To use the expertise of the charity, third and private sectors could be a good move - assuming it is proven expertise, rather than asserted expertise.

But that is not the point.

The point is that meaningful sharing of risk means exactly that. It is not consultancy. It is genuine sharing of risk.

And there is no evidence that that works.

Where risk-sharing has been attempted, with the pharmaceutical industry, it has in the main been evaluated as having worked out as a technically over-complicated and "costly failure", in the case of the BMJ assessment by Rafferty and colleagues of beta interferon.

What risk reserves are we talking about? Already, the Clinical Negligence Scheme for Trusts (CNST) eats up bigger and bigger parts of the budget. What insurer is going to be enthusiastic to offer good rates for cover?

Because their potential exposure to liability could be very significant indeed.

Invisible red ink
Reportedly, Lansley also ducked a question on what will happen if GP consortia overspend, saying merely, "financial ill- discipline" would deprive consortia of  the "quality premium" that will be paid to financially-prudent commissioning groups.

So there is still no developed clue about financial governance either. Marvellous. I love surprises.