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Health policy debate

16 July - 31 August 2005
Introduction
This summary concentrates on health economics and associated debate over the summer. It focuses on two issues: the financial difficulties facing the NHS and debate around the incentive framework being set in place. Some interesting questions are being asked: how can collaborative working be incentivised in a competitive structure and what is the best way to manage a separation of provision and commissioning in primary care.

A series of dry documents with big implications for the future of healthcare have fuelled discussion. Reform is continuing apace and debate over the summer has helped elucidate where some see ‘system reform’ is taking the NHS.

• The consultation on the proposed code-of-conduct for payment by results is effectively the new rule-book for quasi-market behaviour and is an opportunity to make joined-up comments about how the system should be shaped in practice. A debate is gathering pace on whether and how tariffs can be unbundled, for example.
• The decision to bring ideas from the social care green paper into health could mean that its central idea – individual care budgets for clients – could be transferred to the management of long-term healthcare conditions. Someone with chronic asthma would be given resources to purchase the care they need, with a choice of providers. It has implications for the workforce. Last December, community care minister Stephen Ladyman said that in future those employed in social care will have portfolio careers, working for firms providing services or employed directly by clients, both financed from individual care budgets. If the idea is pursued in relation to healthcare it will revolutionise provision.
• Commissioning a patient-led NHS may have been slipped out quietly on the last Thursday in July, but it is a starting gun for fast and far-reaching change in primary care structure. The new PCTs will manage a market of competing providers and will no longer provide care. They will shed employees who will move to new jobs. Where will they go?

Even in high government, there are signs that a renewed economic focus is leading to new ways of working. Patricia Hewitt has been holding meetings with work and pensions secretary, David Blunkett to discuss how the NHS and Department for Work and Pensions collaboration could save the nation money.

In a Fabian Society speech, Ms Hewitt said she and Mr Blunkett had had ‘useful discussions’ about how their departments could work together to reduce dependency on incapacity benefit.

“I was horrified to realise that 40 per cent of people claiming invalidity benefit are claiming it because of mental illness, in most cases depression and stress”. “There is a whole issue about mental health services, but I think the NHS and GPs haven’t really seen it as their role to think: can they do something to help people stay in work or go back to work”.

‘She said one of the best antidotes to depression was getting back to work. “If the NHS does do more then the savings will be felt in the DWP budgets, although the expenditure will be by the NHS. So we are looking at how we overcome the divide between costs and benefits and how we can collaborate”[Go to note 1].