Editor's blog Thursday 11th March 2010: NHS Confed rise to challenge of dismal debate on NHS austerity and reforms

The NHS Confederation have issued a new report, Rising to the challenge: health priorities for government and the NHS.

This short document is basically a public briefing to the major Westminster parties - an anticipatory challenge to the lack of clarity over “what the three main parties believe are the appropriate national and local policy levers for responding to both the financial challenge and the broader requirements to deliver high-quality healthcare and health improvement”.

Rising To The Challenge adds that it “is not intended as a blueprint or management plan”, but both a call for clarity and a ‘greatest hits’ of past policy mistakes, the repetition of which would be A Bad Thing.

No time Toulouse on financial challenges
Its three sections cover challenges and priorities for the NHS; challenges and priorities for the next government; and learning the lessons of the past.

Boldly - and obviously sensibly - the document states that “the NHS cannot and should not wait for government action to respond to the financial challenge”.

Jings. Boy Wonder Andy Burnhoid and Mike "name and shame" O’Brien will be cross – that’s tantamount to people conducting "their own mini-spending reviews", like what Boy Wonder told managers at the Kings Fund and O'Brien told NHS Alliance not to do.

You never know; some very silly people might even have listened to them.

Regulation and inspection get it in the neck – “bedevilled with duplication and unnecessary bureaucracy … there is a need to look again at the purpose of regulation and whether the balance between national and local regulation is right”.

Past policy errors include restructuring and its opportunity costs; top-down targets’ unintnended impacts and disempowering tendencies; and the tendency to view every policy through the prism of planned elective care.

The NHS’s three key focuses should, it suggests, be:
- redesigning care within organisations
- redesigning care between organisations
- and providing effective, evidence-based care

The next government should continue with what is working and tackle what is not working, apparently.

But oh dear, the Boy Wonder is going to be cross again: it suggests that policies which should keep going include “use competition and contestability to improve services and create a challenge to existing providers”, and “encourage new entrants – although more needs to be done to encourage those that offer genuinely new ways of providing services, rather than new versions of the existing approach”.

Phew. It’s almost as if some people at the Confed think the Boy Wonder's "preferred provider" policy, and recent dodging of a kicking from the CCP are really bad ideas.

A new GP contract alert
Ulp. The Confed have come out with the scary suggestion that “that a new GP contract is needed to support reform, better integration and greater choice of GP”. Out with MPIG; redesigning incentives and payments (especially with relation to pharmacy) to encourage scale and negotiation. BMA’s going to love this. Who fancies the negotiations?

A call for courage on closures
Double-ulp. There is a call for courage on hospitals. “Changing the pattern and content of hospital provision is inevitable. Whole hospitals may need to close, although it is more likely that they will need to adapt their character significantly. The party that wins the election will have a key role in helping to lead a debate on this, while the NHS continues to improve the way it involves local people to help them understand the difficult issues involved and the need for these changes”.

Smartly, it suggests that a key lesson for better policy should be to “focus on what, not how”, and keep a patient-centric focus - rather than emulating past one-size-fits-all approaches.

It also sagely notes that “in the past, the NHS has suffered from an over-abundance of initiatives. In these times of austerity, policymakers may not be able to create new initiatives quite as easily, and must resist the temptation to do so. Initiatives require management so, if NHS management is to be cut, this will need to be matched with fewer initiatives and targets”.

A strong conclusion
It is the words of the conclusion that show the Confed at its candid best: “the quality of the public debate about finding solutions to the funding problems has been very poor. While protected funding for the NHS has been promised from all sides in the political debate, these promises are not seen as credible”.

This is no fence-sitting. It rightly states that “the idea that the financial pressures can be met simply by cutting management and bureaucracy is plain wrong. While there are significant savings to be made here, such proposals greatly underestimate the scale of the problem and overestimate the size of NHS management”.

It also trails another piece of work on “being realistic about the inevitable trade-off between pay levels and jobs”.

The Confed must be applauded for the clarity and straight-talking of this document.