Editor’s blog Wednesday 24 March 2010: Budget, Bundred, productivity down again and commissioning chaos

Morning (as in afternoon). You'll have seen the latest Maynard Doctrine on boomerang health policy. If not, do so now and then come back here.

Oo-kay. So nothing from darling Chancellor Darling about the efficiency savings (indeed, they’ll be funding free social care, so long as you don’t actually need any).

And Cameron’s response was basically ‘vote Conservative’. Hey-ho.

Ian Duncan Smith gave a far more effective response (that if re-elected, Labour will have to  cut all departments’ budgets) – but it was to BBC News, after the events in the chamber.

But the tax information exchange bit wth Belize was quite a deft touch.

More on new Monitor chair Steve Bundred
All I really knew yesterday about new Monitor chair Steve Bundred was that he’d been CE of the Audit Commission after Sir Andrew Foster.

A few points to note today.

Firstly, we can safely assume Bundred is not the new Bill Moyes: sounds obvious, but the press release reminds us that the job is “part time, initially for three days per week with an annual remuneration of c£75,000”.  Which means less time to fight with Sir David Nicholson and ministers over that pesky independence thing.

Secondly, like Sir David Nicholson, Paul Corrigan and Alan Milburn, Mr Bundred is A Man Of The Left, Reform’d.

When Bundred’s 2003 appointment to head the Audit Commission was announced, John Carvel wrote in The Guardian that he “was a leading figure in Ken Livingstone's Greater London council from 1981 to 1986 as it tried to challenge the Conservative government's spending controls”.

It’s unclear whether Bundred was in fact such a “leftwing firebrand” as John states in his opening, though. Stephen Bundred was indeed a Labour Greater London Council councillor, representing Islington North from 1981 – March 31, 1986. And he had previously been head of the National Union of Mineworkers' research department (1975 to 1983).

However, the article on rate-capping on Wikipedia (yeah, sorry) “A budget setting the rate at the maximum allowed by the cap was defeated by 59 to 30 with both Livingstone and McDonnell opposed. The (meeting was adjourned until Sunday 10 March, at which meeting a second attempt to set a budget at the cap level was rejected by 54 to 34. After a further budget proposed by the Conservative group was rejected, another budget at the cap level was proposed by Steve Bundred but again rejected by 53 to 36”.

Note that, folks “at the cap”. Not over it, a la Ken Livingstone. Bundred's rep for being tough on overspending was reinforced during his tenure in charge of Camden Council (1995-2003), which he successfully turned around into a high performer.

Productivity down again
Meanwhile, the faboulous Nick Timmins has spotted that latest ONS figures show that not only has “NHS productivity fallen by 3 per cent (0.4 per cent a year on average) since 2001 … the biggest annual fall – 0.7 per cent – occurred in 2008”.

The productivity fall is not wholly surprising per se, given the increase in staff numbers in those years. More staff equals less productivity. More regulation and box-ticking also equal less productivity.

Nick also acknowledges that the quality metrics of ONS figures are not there yet by any means. The ONS themselves admit that it’s “very difficult”.

But the fall since 2008 is intriguing. Why? More NICE guidance driving care into acutes?


Finally, there is an interesting post on the Nuffield Trust blog, where their head of policy Judith Smith looks at the relationship between integrated care and commissioning. It’s interesting because in one version of the future – that of vertical integration under acute trusts – there won’t be any commissioning.

Then again, some are not sure there is any commissioning now. There certainly isn’t enough practice-based commissioning, or PCT co-operation.

The latest DH practice-based commissioning (PBC) survey attempts, in the covering note, to put some proper comedy spin on the poor state of events.

Can you find it in your cynical heart to rejoice that PBC leads report:
- 27% rate the speed of PCT decision-making for business cases once submitted as good
- 20% don’t even have a budget from their PCT
- 24% haven’t agreed a commissioning plan with their PCT
- 91% report that they have at least a little involvement in addressing variation in primary care use of resources or referrals (yes, that’s “a little”)
- 83% have submitted at least some business cases or service redesign plans to their PCT this financial year …
- … but only 69% have had at least some implemented
- 56% of leads report that PBC has influenced the clinical practice of the GP practices within their group (either a great deal or a fair amount), so …
- … 44% consider that this policy has had slight or no influence on local clinical practice

Me neither.