Monday, 18 March 2013

NHS Commissioning looks poorly

I had thought we had done away with public flogging but today's Public Accounts Select Committee certainly gave me cause to doubt that. What was even more bizarre was that some of the witnesses appeared to be wearing self-written sandwich boards which said "I haven't really prepared for this grilling and I don't plan to demonstrate any humility today and certainly not accept personal accountability".

It was a gruelling session for all those involved and the patience of the MPs seemed to be sorely tried - I may return to some of the evidence in more detail. Four points though are worth reflecting on and one worth discussing:
  1. Hospital consultants appear to have negotiated wonderful contract which led to being paid more and being less productive. 'Pay more for less' just isn't that best outcome for a buyer from a negotiation.
  2. The reason why we are 'paying more for less' is, believe it or not, being a consultant has become more complicated in the last decade. I'm sure that's not what they meant to say but they made a point of reiterating that argument.
  3. There was great play made of the presence of annual plans for clinical consultants. The committee appeared to struggle to understand why their presence alone was worthy of credit while the lack of an associated performance management system.
  4. There is a need to really understand what you have authority to do - our friends seemed unsure whether Treasury Guidance, because it had been around for some time, still needed to be adhered to.
However, there was another strange twist in the Clinical Commissioning Group saga, now we find "Commissioners should only use competition where there is evidence it works". I would have liked the Committee to have been more probing on this statement and what the guidance will say. Given the conflicts of interest we discussed on Friday this does not strike me as a good foundation for achieving value for money:

  • What will be acceptable evidence that competition works?
  • What incentive would there be to try to prove competition works?
  • Will it be possible for potential challenges that 'competition doesn't work'?
  • What incentives will there be to ensure that those who have demonstrated poor negotiation in hospital consultants' contracts will be able to negotiate contracts without competition? 
It is certainly is an interesting precedent to set and one which I am sure others will crave for. Why on earth did the Public Accounts Committee let that pass?

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