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I have been resisting the temptation to get involved in this however at
the risk of inflaming this debate I agree with Trish that PCTs and SHAs
(not sthg which you mentioned but I will include) added an unnecessary
level of bureaucracy in the delivery of health care. In particular the
number of top down targets and the administration of funding was ill
thought out and caused countless headaches.
However there is no doubt in my mind (speaking as one of the former
management consultants involved) that the waste that propagated
unfettered (particularly in PCTs) was astounding. The main issue is a
failure by budget holders to appreciate that the use of public money has
to be justified in all cases. The number of run ins I had with budget
holders still astounds me. The majority of the budget holders are not
finance people and with demand always outstripping supply it is
increasingly difficult to rein these budget holders in.
I also read excerpts from Philip Green's report on government spending
and I cannot more wholeheartedly agree with his assessment on the
inadequacy of the practices in (as far as I was concerned) the health
service. The last Trust I worked for had a turnover of over £400 million
yet never once did they attempt to get a collective bargaining agreement
with any of their suppliers to drive down costs. If I went into the
practices of particularly the IT arm of the Trust I could sit here all day.
Countless times (despite the fact that the SFIs demanded it) supplier
contracts did not go out to tender. The fact is that the finance
department was overloaded anyway with the need for constant reporting to
the DoH, but budget holders did not go through a tendering process and
were not prepared to realise savings as a result. The Labour government
solution was always to throw more money at the problem rather than try
and identify the problem.
The problem is that even in the PCT there were too many chiefs who were
unaccountable but even if you take that out of the equation, the Labour
government could have been pursuing collective bargaining agreements
from the very top. They didn't and there just isn't an unlimited pot
when it comes to health spend. Budget holders fail to understand that
any money that was saved would be money earned to be spent on healthcare.
I broadly agree with the move to Foundation Trusts. The main reason
being that unlike PCTs, Trusts and SHAs, any profit they make can be
reinvested into healthcare in the following financial year. With the
other NHS organisations it all functions on a financial year basis
meaning that the accounts had to be clear by year end, meaning no more
than £500 left in the accounts by March 31st or you lose funding to the
value of what you have left in the accounts in the following year.
Healthcare doesn't function on a financial year basis.
Eliminating the middle man (PCTs and the SHA) may well workout as far as
cost saving is concerned, however from my dealings with GPs in the first
PCT I worked at I don't trust GPs to administer their own budgets.
I guarantee you after the first handovers occur that the audit reports
that result in the first financial year when this goes live and
consortia are in charge will not be pretty. I suspect they will be
scathing unless the GPs have a clear understanding of what managing
public funds is about. They have to be beyond reproach.
In the short to medium term I'd be advising anyone who resides in the UK
to be considering private health insurance, because in the short to
medium term until GPs understand the scrutiny that they must undergo and
the need to stay within budget I can only see the quality of healthcare
declining. I read an article some years ago that stated that about a
third of GPs have private health insurance which tells you what they
themselves think of the system.
In fairness to the government they had few options with regards to the
NHS. They have a fixed 5 year term, the need for reform was unquestioned
they decided to take the most radical of options in the hope that in 5
years they will reap the benefit. It remains to be seen whether they
will have a positive effect or not.
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