Daily Comment / Health

Firms to run failing NHS trusts
Source: BBC, 4th June, 2008
Private firms could be drafted in to run struggling NHS hospitals and primary care trusts in England, ministers have announced.

There are 20 Trusts that could be affected and the underperformance could be due to a number of factors, not just poor management. But a fresh pair of eyes, diligence to answer some tough questions and some bold moves to take corrective action, can go far. It’s not easy to find great leaders that are willing to take on basket cases, so perhaps private sector intervention is the answer in such situations. The NHS is no Marks & Spencer, but look what Stuart Rose managed to achieve there (and well done on the knighthood Mr Rose).

Nicholson hails headroom created by £1.7bn surplus
Sources: Healthcare Finance, 4th June, 2008; timesonline.co.uk, 27th May, 2008
A compilation of strategic health authorities, shows the service will return an aggregate surplus of £1.7bn but there’s suspicion it could have been much higher; closer to £3bn.

Accusations of spending jiggery-pokery aside, the NHS’ financial progress over the last few years tells a gratifying tale (see the chart below).

So how’s that surplus going to be used? If it were our money, we’d invest it in two areas:

1. Leadership (at every level). This involves a combination of incentives, training and better appraisal/ accountability. There needs to be stability in the leadership of an organisation and it should be possible to construct something that a) allows the best people to rise to the top and b) makes it attractive for them to remain there
2. Service delivery innovation. This is harder – the NHS doesn’t make it easy for clinicians to capitalise on their innovations e.g. patents. Innovation is key. It drives better outcomes and, we’d argue, productivity. Productivity means more care for your buck, that’s a good thing.

BMI opens 24 hour emergency care centre
Source: Laing & Buisson, 1st June, 2008
BMI Healthcare has opened a 24-7 self-pay emergency care centre at its Clementine Churchill Hospital in Harrow, north-west London.
Emergency care (albeit in limited areas), is now no longer the preserve of the NHS. It’s certainly one way of skipping the queues at A&E and at £47 a pop, to get seen in 15 minutes, it’s not necessarily bad value.

Hospital funds tied to patient satisfaction
Source: HSJ, 22nd May, 2008
Funding for hospitals in England is set to be linked to performance by using patients’ experiences to measure quality of care.

This is the proposed next stage of Payment by Results – factoring patient experience criteria into tariffs. All good in principle, it’s the sort of carrot that should drive quality and outcome improvements, but what a pain to administer. Why not award great providers a bonus? Leave the tariff alone and track outcomes and patient experience separately, that avoids complicating an already complex system (as mentioned in the above article).

HRG tariffs are currently skewed to the provision of hospital care. Given the anticipated greater role of primary care provision, the tariff may come under pressure from primary care providers to be unbundled. In that case, the provider, whoever it is, should be accountable for patient experience – and those criteria are likely to be different for each type of provider.