Posts Tagged ‘NHS reorganisation’

Why the government’s cost estimates for delivering its NHS reforms are wrong

27/02/2012, 08:42:23 AM

by Paul Crowe

The Lib Dems are tabling hostile amendments in the Lords, the former chief executive of the NHS has broken ranks to voice his disapproval and the BMA is balloting on industrial action.

Just another day in the progress of the health bill.

As the lords set to work on the bill later today, the focus will be on amendments on competition in the health sector.  But as the debate progresses they would also do well to focus on a number which has escaped proper scrutiny:- £1.3bn.

That’s what the NHS reorganisation is going to cost, according to the government.

The figure is contained in a report whose very title seems to discourage interest: Co-ordinating document for the Impact Assessments and Equality Analysis. This gives the detail of the projected costs. It’s a classic of its type: sober, measured and with an authoritative tone.

And hopelessly wrong. The £1.3bn identified will be almost certainly just the start of the spending.

To anyone with even passing experience in managing large-scale reorganisations, the department of health’s assessment should flash more warning lights than the police switchboard on riot night.

The £1.3bn figure is made up of redundancy costs of £1bn for 17,000 staff and £300m of what the department calls “one-off transition costs…around IT and property”.

In return, the government expects to make a £1.5bn saving each year after the change is implemented, giving a net saving of £3.2bn over the course of this parliament. Impressive.

Or it would be impressive were it realistic.

Few disagree on the need for reform in public services, particularly in economic times such as these. And change, when implemented in the right way can achieve the savings needed and improve care in line with the traditions of the NHS.

But looking at the scale of what the department of health is attempting and comparing it to recent corporate reorganisations, three problems are soon apparent.

First, the savings are aggressive given the costs; second, the costs identified don’t appear to be complete; and third the timetable for achieving savings is optimistic to say the least.

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The “new” health bill is a PR fix. Scrap it and start again.

28/06/2011, 09:30:45 AM

by Liz Kendall

This week, some parts of the government’s health and social care bill will go back through the committee stage of scrutiny by MPs.

David Cameron and Nick Clegg say they have listened and acted on people’s concerns. Now we’ve seen the government’s actual amendments to the bill, how does their claim match the reality?

The first problem with the government’s new NHS plans is that they are an even bigger mess than they were before.

Initially, the government wanted to scrap primary care trusts and strategic health authorities, set up the NHS commissioning board, public health England and the new monitor at the national level, and GP commissioning consortia and health and wellbeing boards at the local level.

Since then, new clusters of PCTs have been formed to “manage the transition” and David Nicholson, the chief executive of the NHS, has made it clear that he wants to have regional outposts of the NHS board (SHAs anyone?). Following its listening exercise, the government says that GP consortia will become clinical commissioning groups. It also wants to establish new clinical senates and have a bigger role for clinical networks.

These organisations come on top of the bodies that already exist, including the national quality board, the national institute for health and clinical excellence and the care quality commission.

Confused? You should be. It is now completely unclear who is responsible for taking decisions and leading changes in the NHS.

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GP commissioning: how some GPs could make a shed load of money

07/03/2011, 12:00:29 PM

by Andy Howell

Do general practitioners (GPs) stand to make enormous profits on the back of the government’s GP commissioning reforms? Government ministers have responded to such suggestions aggressively, arguing that recent stories to this effect are simply the result of scaremongering of behalf of their political opponents.

However, talk to almost anyone involved in running local health services and they will tell you that it is inevitable that there will be huge profits to be made by GPs through commissioning, and they are not happy about it.

But if there are huge profits to be had, then how are they to be made and where will we have to look to find them? Will the opening up of GP services to profit-based ventures change the nature of our NHS forever?

It is not difficult to find experts in public sector organisation and finance who will tell you how they expect the new commissioning service to develop. Here is one such scenario that maps out what we might be letting ourselves in for.

Initially, I thought it might be difficult to monitor profits and to understand exactly how they were being made. After all, GP practices are not limited companies and as such they do not produce public accounts. But the experts tell me that it is not in established GP practices that money is to be made.

The new profits will come through newly commissioned services which, as limited companies, can be developed in very different ways to traditional GP practices. The key to understanding how the money may be made involves appreciating that local GPS will be able to be both commissioners of local services and providers of local services at the same time. There is no rigid separation of purchaser and provider here.

Let us consider two GPs who work on the same patch. Let’s call them Fred and Sally. (more…)

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No mandate for the biggest NHS reorganisation for 63 years

23/01/2011, 09:00:17 AM

by Amanda Ramsay

U-turn Dave, along with his Tory and new Lib Dem colleagues, made many an empty promise during last year’s general election campaign: VAT would not rise, frontline services would not be cut, the educational maintenance allowance would be safe.

And the Fib Dems promised the abolition of tuition fees, subsequently voting to triple them. The latest non-mandated policy is the health and social care bill, introduced to the Commons this week, heralding the largest reorganisation of the NHS since 1948.

This is despite the coalition agreement committing to quite the opposite, clearly stating: “We will stop the top-down reorganisations of the NHS that have got in the way of patient care”. In addition, the government’s health reforms feature in neither Conservative nor Liberal Democrat election manifestos, prompting Andrew Neil to ask on the BBC’s Daily Politics: “Are manifestos worth the paper they’re written on”? It is an alarming precedent. (more…)

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