UK National Health Service reforms IV

“Doing the wrong thing more slowly is not the answer.”

(John Healey, Labour Party politician, former shadow health secretary, 2011)

Reform

Radical changes lie ahead for the NHS and decisions are to be made. Conservative Health Secretary Andrew Lansley acknowledged that there are a few things more worthy of discussion. Earlier this year the UK government announced a “listening exercise” with a view to “listen, reflect and improve”. But was this really about policy making or was it just another political chess move?

“Organizational reforms require comprehensive change along different dimensions of the system. Successful reform of complex systems depends on Consistency and coherence relate partly to whether the different components of the proposed reforms have been adequately specified, and partly to the relationship of these components to each other as part of the reform package. Even if these issues are addressed at the design stage and aligned appropriately, implementation deficits may crop up. These may arise because policy-makers depart from their plans during the implementation or because the context is hostile. Actors may also try to delay or divert implementation because their interests are adversely affected.”(Mark, L. Annabelle et. al, Innovations in Health Care – A reality check, 2006)

Personal reflection

During my study trip in Manchester I had the exceptional opportunity to gain insight into the NHS and the approaching changes in the UK health care system. Our visitations to several health care-related institutions, like the “Central Manchester University Hospitals NHS Foundation Trust”, the “National Institute of Health and Clinical Excellence” (NICE), the “Together Trust” or “The King´s Fund” in London gave us a comprehensive and systematic overview of how the health and care sector works in the UK.

Appropriately enough, one of my fellow students acquired free insight because she had an involuntary hospitalisation. The fact that she came back in sound condition, makes me confident, that the NHS works well.

What more need be said?

Conclusion

I think the British are aware of the advantages the NHS provided them with over the last 60 years. Bearing the comparison between the NHS and religion in mind, we can say without thinking twice, that they know, which denomination they belong to. The health care reforms have provoked a lot of controversy and that – in fact – is a good thing.

“It takes a long time to achieve fundamental health sector changes. The degree to which a health system can change a health determinant is related to the time frame of the analysis. Many health sector reforms and institutional changes may take several years to have their full effect and thus require a longer-term perspective for assessment.”(Mark, L. Annabelle et. al, Innovations in Health Care – A reality check, 2006)

I for one will keep an eye on the NHS.

 

 

 

UK National Health Service reforms III

“Fear is the path to the Dark Side.” (Yoda, Star Wars – Episode I, 1999)

Commissioning

“Commissioning in the NHS is the process of ensuring that the health and care services provided effectively meet the needs of the population. It is a complex process with responsibilities ranging from assessing population needs, prioritising health outcomes, procuring products and services, and managing service providers.” (Department of Health website, archived content, 2010)

Relating to Commissioning a transition took place over the last 14 years and it led straight into the so-called “practice-based commissioning”. It was a functional interaction between Primary Care Trusts and GPs. In 2010 the health White Paper “Equity and excellence: Liberating the NHS” (became the “Health and Social Care Bill 2011” earlier this year) was unveiled and that changed almost everything. If passed, PCTs are history and general practitioners (GPs) take over control of commissioning and budgets. Put simply, apart from their job as health care professionals they become managers too. The word is that, in doing so, they “go to the dark side”, juggling with figures instead of scalpels and stethoscopes. (The GPs on the ‘dark side’, Brennan S., guardian.co.uk, 2011)

Anyhow, this is not the time to become one-sided in the line of argument. Actually, GP fundholders (general practitioner-led commissioning system in the 1990s) have shown evidence of their capabilities in commissioning. They were able to reduce expenditures like prescribing costs and brought down hospital referrals. Moreover they proved to be more sceptical about the    service offered by the various providers, which could push innovation and improvements in hospital services. They were in the thick of the action and therefore well briefed. Then again they had higher transaction costs than administrative commissioners.

Commissioning is not the only area in the NHS that faces huge changes. The whole NHS bureaucracy will be reconstructed. Will GPs come to stay in their new role? Will the system be economised without causing any damage? Questions upon questions. There´s more to come.

What is the Status Quo?

To be continued.

 

UK National Health Service reforms II

“Managing a beast like the NHS is difficult in the extreme [….]”
(Richard Smith, guardian.co.uk, 2006)

Management

“Management matters. Without it, nothing happens. From deciding on and
buying the weekly grocery shop to designing, building and running the giant
atom-smasher at Cern, nothing effective happens without budgeting, scheduling
and implementation.” (The future of leadership and management in the NHS,
The King´s Fund, 2011)

Nonetheless “Management” is often associated with terms like bureaucracy or
even considered a millstone around an organisation´s neck. Why is that? In his
presentation “The Experience of the Healthcare Manager” Dr Edward Granter
(Manchester Business School) showed clearly, that there is a traditio-historical
and archaic picture of the “typical manager”. Especially middle-level managers
are in bad odour. Their counterparts, the health care professionals in the NHS,
are seen as the “real” heroes, the people who get the job done. Hardly surprising,
that there have been animated discussions on this issue over the last fifty years.
The most important question seemed to have been: “How can we find an
accomplished combination and who´s in charge?”Alongside with the division of
management-tasks there is also a discussion on leadership and how it should
look like.

Leadership

The King´s Fund Commission on Leadership and Management in the NHS
describes leadership “as the art of motivating a group of people to achieve a
common goal.” (The future of leadership and management in the NHS, The
King´s Fund, 2011)

In a breath they suggest “The „post-heroic‟ model of leadership”, where – in
short – a form of distributed leadership is postulated. If I have understood
correctly, they aim for “No more heroes” in the NHS but somehow or other for
more heroes across a broad front, who grasp the nettle and collaborate
interdisciplinarily.

But who is in charge?

To be continued.

 

UK National Health Service reforms I

“The National Health Service is the closest thing the English have to a religion.”

(Nigel Lawson, former Tory chancellor)

Hearing this quote for the first time, it was clear to me, that the NHS is an important matter to the British people. There are several convincing reasons for this attitude towards the National Health Service. Currently, radical changes take place and maybe this is the proper time to ask whether these changes constitute an homage or heresy.

In the government´s NHS White Paper, “Equity and excellence: Liberating the NHS”, it says: “The NHS is a great national institution. The principles it was founded on are as important now as they were then: free at the point of use and available to everyone based on need, not ability to pay. But we believe that it can be so much better – for both patients and professionals.” (Liberating the NHS, Department of Health, 2010) Summarizing the changes in near future, we can take down the salient points: a patient-oriented service, measured against results of patients health conditions and an increased involvement of doctors and nurses in the decision-making process.

Competition

Fair enough, but let´s get straight down to the nitty-gritty. In order to extend patients choice on health services offered, the “liberated” NHS will provide the patient with the “choice of any willing provider”. The most competitive health care provider will create the best service, that´s the basic idea. This provider will do its best to do a heck of a job to mould the best service. But being a part of the private sector, its main concern can never be a patient-oriented but rather a profit-oriented point of view. Competition is a characteristic feature of the market economy. According to the allocation theory, the amount of money, a person is willing to pay, is a good indicator for allocation mechanism. Let me get this straight: that´s not really an issue, but only if the government is determined to focus on its core task: to retain the central idea of the NHS, namely being “available to everyone based on need, not ability to pay.”

Where do we go from here?

To be continued.