Health Matters | Paul Corrigan's blog

Blog readers will have been following the twists and turns of the Secretary of State’s attempt to change the policy of the NHS to enforce his personal preference for the NHS as preferred provider.

Last week Society Guardian reported the end of the line as follows:

The health secretary, Andy Burnham, has lost his political battle to protect the NHS against competition from the private and voluntary sector. He had declared his intention to make the NHS a “preferred provider” of health services: some primary care trusts took this to mean independent healthcare firms and social enterprises should be excluded from bidding for contracts. Burnham’s ambition was seen by some as a sop to Labour’s trade union funders, and an attempt to re-establish the party’s anti-NHS privatisation credentials. Complaints were made to the NHS competition commission, and there were reports of disputes in cabinet over the issue. Today, the NHS published its revised guidance, which appears to blow Burnham’s ambitions out of the water. Stephen Bubb, chief executive of Acevo, which represents charities that provide public services, said:

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One of the interesting meetings that I had whilst in Portland – the largest city in Oregon – was with nurses in one of their biggest hospitals – Providence.

I have been in the US with the excellent Helen Bevan – Director of Transformation at the NHS National Institute. One of the things we have been discussing in all our meetings is whether US hospitals would be interested in using one of the improvement tools developed in the NHS – the “productive ward”. The “productive ward” is a nurse-led project aimed at working with nursing staff on the ward to release staff to devote more time to care. It’s aimed at cutting out waste and is, in many ways, a classic time and motion study. The difference is that this study is carried out and implemented not by “men in suits” but by the nurses themselves. Some of the improved output figures are very good.
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It’s rare for one of my posts to be written through tears (although of course that doesn’t mean that many of you don’t end up reading them that way!) but by a quirk of history I am in America on the same day that President Obama’s Health Care Bill is passed.

The excitement of this comes from several sources.

Firstly and most significantly, this will extend coverage to tens of millions who have lost their health insurance through unemployment – in the US most employed people and their families are insured through their employers. When we lose our jobs in the UK it’s a big tragedy, but we still keep our health care. When someone loses their job in the US they and their family lose their health insurance. This means they often have no cover for illness at all. Given the high level of unemployment at the moment this is a big issue.
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I am in the US for a few days carrying out some work with a health care plan in the state of Oregon called Care Oregon. It’s an exciting week to be here because President Obama’s health bill will, or will not, make it through Congress this weekend. As that happens I will be in Arizona at a conference of all the Community Health Plans in the US. The people I will be with are great supporters of reform and for them it will either be the high spot of their decade – if it goes through – or the low spot – if it doesn’t.

So the weekend promises to be exciting, one way or another, and I will post on the outcome. My money – with 2 days to go – is on the President getting the reform Bill through (but I am not saying that to people over here who are into not counting chickens …)
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As the election campaign gears up, one of the most important developments in health reform for several years has just happened.

One of the leading patient organisations  - National Voices – has launched a campaign that changes the terms of trade that normally represents patient opinion in the lead up to an election. National Voices is a coalition of more than 200 health and social care charities providing a collective voice for patients, carers and service users.
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…except in the NHS where he keeps telling us he won’t be

David Cameron made an interesting speech to the Welsh Conservative Party at the weekend. His political problem is that whilst I am the sort of nerd to find code breaking interesting, most people don’t really know what he means. I know, I am sad, but there’s nothing that is more fun for me that decoding the weird text of a senior politician.
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The story so far…

Last September the Secretary of State for Health made a speech where he declared that his personal preference was for NHS providers to provide care for NHS patients. Since then he has been trying to impose this preference on all NHS Commissioners.

The problems of the last few days stem from the fact that he has been successful in bending some PCTs to his will. A letter from David Nicholson drawing their attention to his policy, resulted in some PCTs limiting their approach to tendering to those service providers that the Secretary of State prefers.
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If some of this post reads oddly it’s because it reports on a seminar that was held under Chatham House rules. These rules mean members of the seminar are not allowed to say what someone said at the seminar but you are allowed to say that it was said. This allows people to say what they think without fear of attribution leading to a consequently free-er discussion.
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Sometimes I write about things that start off looking so esoteric that I nearly lose my nerve in starting to write about them, let alone encourage the reader to read them.

But here goes.

In the autumn of 2003, when New Labour was in the last set of trenches getting the NHS Foundation Trust legislation through the Houses of Parliament, someone came up to me and congratulated me on creating the fuss around Foundation Trusts as a smokescreen for the really important change. They said that whilst FTs were important they were acting as a smokescreen for the creation of a pricing mechanism for the NHS – what came to be known as “Payment by Results”.
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