Best Value in NHS banished to back room

4 Nov 99
The NHS will be spared the rigid Best Value regime imposed on local government and will focus on back-room support rather than clinical services.

05 November 1999

Health Secretary Alan Milburn is currently considering applying the principles of the town hall Best Value initiative to the health service. But the new system will not extend into front line clinical services and will be far more flexible than its counterpart in local government, Public Finance understands.

Health service managers have raised fears recently that Best Value, seen as an over-bureaucratic and over-audited initiative, will be transferred wholesale from town halls into the NHS. Scotland is already on the verge of extending the initiative to the whole Scottish budget (Public Finance, October 29) and the proposed new guidance makes it clear that England is not far behind.

The NHS Executive has accepted some of the principles of Best Value, such as improving collaboration and consultation. But it believes that the rigid structure of the procedure in town halls, with auditors watching councils' every step and signing off Best Value plans, is unnecessary in the health service, which is more trusted by the government.

The Executive believes existing performance management systems, including clinical and corporate governance, controls assurance, the National Institute for Clinical Excellence and the new Commission for Health Improvement, together with annual visits to all NHS bodies by regional offices of the Executive, already provide the backbone of a Best Value system.

Managers this week reacted with surprise that guidance was in the pipeline. Although relieved that the town hall version of Best Value was not heading for the health service, Janice Miles, policy manager at the NHS Confederation, said with the health service already suffering from 'initiative-itis', any new initiative was unwelcome.

'I'd be concerned if this was imposed, especially if there was a time frame,' she said. 'It adds to the list of priorities and we had been hoping for a period of settling down.' She said that support services were not a significant part of NHS expenditure and a new initiative 'diverts attention away from the major agenda'.

In reality, Best Value in the NHS looks like being a repackaged version of the old market-testing legislation, first issued in 1983, which requires health bodies to market-test three blue-collar services in catering, cleaning and laundry.

The scheme, which was updated in 1993, has been under review and it is this policy, albeit with a slightly wider remit to cover all support services, both blue collar and white collar, that is being rebadged into Best Value.


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