How about a bonfire on the inconsistencies?

Civitas, 20 July 2009

Here’s a good question: where are the Tories going on health policy?  Do they even know?  It doesn’t seem so.  First, the macro stuff.  Is health spending to increase in real terms as pledged, or has – as today’s response to the King’s Fund and IFS’s projections for the NHS tends to suggest – reality finally struck?  Is NHS pay to ‘not depend on how much money the government has’, or is there to be an acknowledgement that the NHS cannot be immune to the effects of the dire fiscal situation?

And then there’s the micro, the latest policy announcements.  Here, on the 2nd July is Mike Penning announcing that the Conservatives are planning to “enhance” the foundation trust regulator Monitor’s role, giving it powers to regulate against poor care and speed up the foundation pipeline.  The former a bit strange, one might think, as it runs into the Care Quality Commission’s patch, NICE’s patch, the National Patient Safety Agency’s patch, Strategic Health Authorities’ patch, the National Quality Board’s patch… perhaps risking yet more duplication in an already crowded regulatory field?  And yet, on 6 July David Cameron is announcing a ‘bonfire of the quangos’.  Hmmm.
And the very latest.  The Conservatives idea to use companies, such as Humana, to carry out practice-based commissioning on behalf of GPs, where they do not want to become commissioners.  Strange again, given that practice-based commissioning’s raison d’etre (at least for the government) is to involve frontline clinicians – particularly those at the primary care end who after all are responsible for referrals – in the commissioning process as ‘agents’ of patients; and to empower them to tailor care to need.  Isn’t that slightly undermined by hiving it off to private companies?  Why, for example, don’t PCTs just hold onto it?  They will, after all, remain statutorily responsible.
Or is there, dare I say it, an underlying feeling – certainly replicated in many corridors of the DH – that, actually, many PCTs and practice-based commissioners are simply not up to the job…. Social insurance anyone?!