Health Matters | Paul Corrigan's blog

It is no secret to say that reforms within the NHS are incomplete. It is even less of a secret to say that much of the culture of the NHS (by which I mean the way in which we do things round here) still resonates with the song of the unreformed NHS.

Why does this matter?

It matters because over the next 4 years the NHS faces an enormous challenge -caused by the mismatch between the increased demand for NHS services that comes from an aging population and, at the very best, an increase in resources that keeps pace with inflation.
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What are the parameters of world class decommissioning?

If world class commissioning consists in part of PCTs commissioning services that provide very good health and health care outcomes and doing it really well, then world class decommissioning involves stopping the provision of services that are less than optimal in health care outcomes or value for money and doing this very well.
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Why World class decommissioning is more important than world class commissioning

On September 16^th the DH launched the second year of the World Class Commissioning Process. This is an important step forward in a number of ways.

• First, this is the first time the DH has recognised that improvement assurance systems require, if they are to really create improvement, needs iteration. It has to happen in a similar way every year so that people are not just randomly examined, but improve on an annual basis.
• Second, they have recognised that whilst the assurance process is very similar to last year with the same rhythm to the process, there are some stark differences to the development of a five year plan in the autumn of 2009 from the autumn of 2008 and these all concern the relationship between resource and outcomes. The same resource will have to buy much better outcomes.

So the process starts with a clear definition of what commissioning is all about.  
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This, the second week in September 2009, has given us greater clarity about the resources that will be available to the NHS over the next few years whoever wins the next general election. There are two sets of milestones that will make this clearer and more specific, but the direction from both political parties is clear.
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The story in the Health Service Journal and several of today’s newspapers is typical (to join the historical analogy of the month) of the phoney war of 70 years ago on the French and Belgian borders.  As a story it is phoney because McKinseys have been recommending that the NHS should have 10% less staff for about the last 5 years. So the fact they think this is hardly news. And the political reactions to it are part of a phoney war,  Government :- How dare they say NHS funding will be need to be cut Conservatives:-  We believe in greater efficiency but – even though it’s two thirds of the costs- this will not touch a hair on the head of front line staff.
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The recent discussion about the US and English health care system has thrown up a number of important facts. Some of them are obvious but some are counterintuitive and need some exploration and discussion.

Whilst we all know that the US spends much more pre head of the population or as a proportion of GDP on their health services than we do, the assumption is that most of this is private expenditure. Surely there is nothing wrong with individuals in a rich country spending their own money on health in the same way as they might spend their money on a third or fourth luxury car. This is private income being spent privately on their health – a set of personal consumer choices.
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The good thing about the last few weeks is that the more that is said about the problems of the coming crisis in public expenditure, the more that it is recognised that the NHS cannot be excluded from its impact. Its true that because of the importance of the NHS there may be a smaller impact on the NHS than say transport, but there is still a recognition that the increases in money of the last few years will stop, but the increase in demand for health care will continue.
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