03 November 2006
Reforms designed to split the NHS into competing provider and purchaser organisations do not adequately address the needs of the 17 million people with long-term conditions, participants in last week's Public Finance/Deloitte round table agreed.
'Seventy to eighty per cent of our costs are long-term conditions, but we lack the means to deal with that if we concentrate only on organisations such as hospitals and primary care trusts,' said Michael Parker, chair of King's College Hospital.
'We need to look at the patient pathway, not the organisations in which they happen to be treated.'
The current reforms – in which providers effectively compete with each other to win contracts from commissioners – missed opportunities both to improve patient care and to save money. This was because there was little incentive for providers to work together or beyond the national tariff to offer the full range of care a patient would need, said participants.
Patients with multiple needs were therefore losing out, for example through the closure of popular and convenient 'one-stop-shops'.
Jo Webber, deputy policy director at the NHS Confederation, said: 'We really have to unpick what it is we want to deliver from the buildings and organisations in which we deliver them in and find new joint venture models to get the delivery right.'
Where integrated services had been introduced – such as through the national frameworks for heart disease and cancer – 'spectacular gains' had been made, said Rod Griffiths, president of the Faculty of Public Health.
But further improvements were now endangered by the competitive ethos of payment by results, 'constant NHS reorganisation', and the problem of hefty institution-based fixed costs.
Caroline Clarke, director of finance at Homerton University Hospital NHS Foundation Trust in Hackney, said the problem could be resolved through the introduction of a per-capita based fee for particular care pathways.
'That would allow organisations like mine to respond to a strong commissioner through some kind of consortia,' she said. 'But the NHS hasn't had a debate yet about how that would work.'
But an adequate solution to the problem was vital if the NHS was to cope with the expected slowdown in funding growth after 2008, said Elizabeth Wincott, chair of the Long-term Medical Conditions Alliance.
Many of the 17 million people with long-term conditions were too sick to work, but better health care could help them return to employment, as well as prevent expensive crisis episodes in acute care.
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