By David Williams
16 April 2010
A public policy academic has added to the calls for sweeping reforms to the commissioning system in the English NHS.
Professor Calum Paton, writing in the British Medical Journal today, says the existing model, with ‘purchaser’ primary care trusts separated from ‘providers’ such as hospitals, is bureaucratic and costly. He says the market-based system is based on ‘yesterday’s dogma rather than necessity’.
Paton’s comments follow a report released last month by the Commons health select committee, which described primary care trusts as ‘weak’ and ‘passive’ commissioners, and concluded that the system has led to increased costs.
A separate study, also published last month by the King’s Fund and Nuffield Trust think-tanks, called for the system to be reformed. It suggested a greater role for doctors and said that PCTs might have to merge to become more powerful.
Paton, an academic at Keele University, told Public Finance that integrated local health bodies could be established, as in Wales and Scotland, to perform the functions of both the purchaser and the provider.
‘It is perfectly capable of working and would have significantly less administrative cost than we’ve developed over the years.
‘Commissioning has failed and it ought to be abolished – but you still need somebody to do the planning of need. Getting hung up on a commissioner/provider split has outlived its usefulness.’
He also described World Class Commissioning – the latest Department of Health initiative intended to improve the system – as ‘an embarrassment’.
David Stout, director of the NHS Confederation’s PCT Network, attacked Paton’s article as ‘not well-argued’, and disputed an ‘unsubstantiated’ claim that the commissioning function generally attract lower-quality managers.
He said commissioning, in the broad sense of assessing need, planning services and monitoring their effectiveness, would always be necessary.
But he stopped short of arguing that competition was the only way to improve services, saying: ‘It’s not inevitable that commissioning implies competition.’
Stout questioned whether the existing payment by results funding system, which rewards hospitals for the amount of work they do, is effective. ‘It’s fine in a time of economic growth where we were looking to grow capacity, but that’s unlikely to be a successful strategy as growth either reduces or ceases altogether,’ he said.
Judith Smith, head of policy at the Nuffield Trust, said the real issue was whether PCTs had the power to commission effectively.
‘Hospitals and other providers of NHS care remain too powerful – they are often adversarial and are not pulling in the same direction as commissioners,’ she said. ‘This must be acknowledged and tackled – but to do so would make life very uncomfortable for politicians and policy-makers, as hospitals would downsize and some services would be curtailed to make way for new ones.’
16 April 2010
A public policy academic has added to the calls for sweeping reforms to the commissioning system in the English NHS.
Professor Calum Paton, writing in the British Medical Journal today, says the existing model, with ‘purchaser’ primary care trusts separated from ‘providers’ such as hospitals, is bureaucratic and costly. He says the market-based system is based on ‘yesterday’s dogma rather than necessity’.
Paton’s comments follow a report released last month by the Commons health select committee, which described primary care trusts as ‘weak’ and ‘passive’ commissioners, and concluded that the system has led to increased costs.
A separate study, also published last month by the King’s Fund and Nuffield Trust think-tanks, called for the system to be reformed. It suggested a greater role for doctors and said that PCTs might have to merge to become more powerful.
Paton, an academic at Keele University, told Public Finance that integrated local health bodies could be established, as in Wales and Scotland, to perform the functions of both the purchaser and the provider.
‘It is perfectly capable of working and would have significantly less administrative cost than we’ve developed over the years.
‘Commissioning has failed and it ought to be abolished – but you still need somebody to do the planning of need. Getting hung up on a commissioner/provider split has outlived its usefulness.’
He also described World Class Commissioning – the latest Department of Health initiative intended to improve the system – as ‘an embarrassment’.
David Stout, director of the NHS Confederation’s PCT Network, attacked Paton’s article as ‘not well-argued’, and disputed an ‘unsubstantiated’ claim that the commissioning function generally attract lower-quality managers.
He said commissioning, in the broad sense of assessing need, planning services and monitoring their effectiveness, would always be necessary.
But he stopped short of arguing that competition was the only way to improve services, saying: ‘It’s not inevitable that commissioning implies competition.’
Stout questioned whether the existing payment by results funding system, which rewards hospitals for the amount of work they do, is effective. ‘It’s fine in a time of economic growth where we were looking to grow capacity, but that’s unlikely to be a successful strategy as growth either reduces or ceases altogether,’ he said.
Judith Smith, head of policy at the Nuffield Trust, said the real issue was whether PCTs had the power to commission effectively.
‘Hospitals and other providers of NHS care remain too powerful – they are often adversarial and are not pulling in the same direction as commissioners,’ she said. ‘This must be acknowledged and tackled – but to do so would make life very uncomfortable for politicians and policy-makers, as hospitals would downsize and some services would be curtailed to make way for new ones.’
