Wisdom from Andy Burnham, MP
Civitas, 1 July 2010
This blog has never been too complimentary to the former Secretary of State for Health, Andy Burnham MP (not least over the whole ‘preferred provider’ politicking), but two recent comments are worth some meat.
One, his view that the NHS should not be protected against real term cuts in funding, which surely makes sense now we know other departments are going to suffer wholly disproportionate cuts of up to 30 per cent as a result. Burnham is clear on the implications of this not least for social care, which, inadequately provided for, will only increase the burden on the NHS:
“If this goes ahead they will hollow out social care to such a degree that the NHS will not be able to function anyway, because it will not be able to discharge people from hospital.
“If they persist with this councils will tighten their eligibility criteria even further for social care. There will be barely nothing left in some parts of the country, and individuals will be digging ever deeper into their own pockets for social care support.”
Also of note here is a study published last week in the British Medical Journal which suggests in a recession other factors such as work, housing and welfare are likely to have more impact on a person’s health than health spending. In others words reducing spending too much elsewhere could well increase demand for NHS care and create something of a false economy (to say nothing of the individual’s health).
And, of course, there is the valid argument put by David Green, Civitas’ director, this week amongst others that there is plenty of fat to cut in the NHS as things stand.
So, onto Burnham’s second pearl of wisdom. His recent tweet exclaiming ‘god bless the Treasury’ in response to reports HM Treasury are carefully examining, the now Secretary of State for Health, Andrew Lansley’s plans to turn some £80bn worth of commissioning away from PCTs over to consortia of GPs. One has to ask exactly why the new Secretary of State thinks this is a good idea. Not least because for all PCTs incompetence we do, for the first time, at least have bodies whose dedicated role is commissioning and have spent the last few years building structures to support this. It will take GP consortia a good couple of years to get to this point – a couple of years we don’t really have to focus on structural upheaval (again). The NHS needs to have one focus: concentrating on driving productivity like never before.
The only justification, then, can be that GP-led commissioning will be substantially better than what we’ve already got. And evidence doesn’t really support this. The current incarnation – practice-based commissioning – has declining support and achieved little. The incarnation before that – GP fundholding – saw some successes, but predominantly where GPs were up for it. The fact is the vast majority aren’t. And budget control – as the HSJ points out today – is a real issue. Commissioning bodies (PCTs) probably need to get bigger, not smaller.
But why not go for something a bit novel where the NHS is concerned: different solutions in different places. Where GPs are up for taking on budgets, let them, but keep PCTs to monitor it carefully, where they’re not, why force them? Let PCTs continue.