14 November 2008
By Paul Dicken
An economist who led work at the Healthcare Commission on value for money in the health service has criticised the commission's approach to evaluating the cost-effectiveness of services.
Peter West, a senior research associate at the York Health Economics Consortium at York University, recently came to the end of a three-year secondment at the commission. He told Public Finance that value for money work was a low priority for the commission and had been sidelined in the organisation, which was preoccupied with developing new areas of work rather than delivering existing ones.
West said there was an 'inevitable tension between quality and efficiency in health and social care', but there had been a lack of willingness by the commission to accept a 'trade-off between quality and costs'.
A paper submitted by the consortium to the parliamentary committee on the Health and Social Care Bill earlier this year raised concerns over the potential for such tensions in the Care Quality Commission, the new health and social care watchdog, which begins work in April 2009.
'It should be noted that the legislation simply gives the new Care Quality Commission the powers to carry out studies of economy and efficiency.
'It is arguable that this should be a key requirement, given the likely future pressure on health and social care budgets. The powers to carry out such studies could be strengthened by making such studies a requirement in future.'
A commission spokeswoman said: 'The Healthcare Commission does a great deal of work on value for money, which we regard as extremely important.'
She told PF that the annual health check of NHS trusts looked at how well money was managed by trusts, including an assessment of value for money, and that the various reviews and studies produced by the commission included assessments of efficiency and effectiveness.
'The commission also has plans to improve its annual health check in 2008/09 by giving PCTs a separate rating for how well they commission services on behalf of their communities,' she added.
The main piece of work carried out by West for the commission, a report into mental health services entitled Bringing value for money to mental health, was published on November 5.
It found a 'lack of connection between the types of development, the budgets for local mental health services, the delivery of services and the achievement of good outcomes or value for money'.
The report was completed at the end of last year and had 'scarcely changed' since then, according to West. But the commission attributed the delay in its publication to 'substantial revisions' that had to be made.
West said it was 'almost impossible for any NHS provider or commissioner to assess the value for money of current mental health services.'
West told PF that the Audit Commission, previously responsible for this area, had a 'good track record' on value for money studies prior to the work being taken on by the Healthcare Commission.
'Unless the Care Quality Commission makes a substantial investment in value for money work and makes it a much higher priority that the Healthcare Commission did, then I think the Audit Commission should take it back,' he added.
He said this would help prevent regulation that failed to fully take account of the trade-off between quality and cost-effectiveness.
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