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Health Department mandarin says reforms are a “nightmare”

John Rentoul

una obrien Health Department mandarin says reforms are a nightmareReading the minutes of the the Public Accounts Committee for 25 January, as one does while one waits for kickoff in the Super Bowl, this leapt out at me.

After a complicated discussion about “risk pools” in the new NHS with Sir David Nicholson, Chief Executive of the NHS,* Richard Bacon, Conservative MP for South Norfolk, asked him about accountability.

What I am really asking is if a GP consortium decides to go haywire and runs off to the Netherlands Antilles with the money — we have seen public money going off to Caribbean tax havens since I have been on this Committee, so it is not such a stupid question — will the chief executive or managing partner of the GP consortium be coming before us to explain his actions, assuming he has not been arrested and in jail, or will you be?

Sir David Nicholson: It will be me.

Richard Bacon: It will be you, okay.

Margaret Hodge (Lab, Barking) (Chair): And will you on hospitals?

This was answered by Una O’Brien, Permanent Secretary of the Department of Health (above):

The accounting officers — which is a different role from the accountable officer of the consortia — are directly accountable to Parliament where there are NHS foundation trusts.

Margaret Hodge (Chair): So we are expected to see however many foundation trusts we end up with?

Una O’Brien: Yes. On the specifics of what goes on inside that operational unit of a foundation trust, that is what the legislation currently says.

Margaret Hodge (Chair): It is a bloody nightmare.

Una O’Brien: Yes.

*The risk pools, a form of pooled insurance between groups of GP consortia, reveal some of the hidden complexity of the new form of NHS market, but Sir David eventually managed to make clear that they would apply to conditions specified in advance. I suspect that the drafting of those contracts is going to be another nightmare.

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  • Expatnhappy

    What on earth do you expect ? The Civil Service is part of the problem. Let them all resign, they are totally and utterly useless people, no ideas, no nothing. Get rid of them, all.

  • http://twitter.com/Broxted Ciaran Rehill

    Dear John, the Netherlands Antilles ceased to exist last year. Please get your facts right, Dank U Wels, Ronaald van der Broxted.

  • irishaxeman

    You read it here first. When the insurance market in the NHS is sorted out, there will then arise a futures and hedge market based on them. The chaos of the free market descends again, and no-one is ever accountable.

  • everytimereferee

    Thanks very much. Met us all have you?

  • Suarez from the car park…

    The idea that you’re ever going to beable to hold private service providers adequately to account is laughable.
    Where demand is inelastic (i.e. custom doesnt go away), private industry will just show you the finger. It always has done.

    To make it worse, the gp consortium (private company) will own all the gp’s in your area, so you can’t even change gp’s effectively without going across town.
    They get paid no matter which gp you go to. The system is starting with a commercial monopoly.

  • Suarez from the car park…

    Get ready for an effective voucher system of health care.

    You will go to a provider for treatment (cheapest / lowest quality) where the provider will up-sell you a “silver or gold or platinum treatment” – if you pay extra of course.

    Older or less effective treatments will remain the ’standard’ nhs offering. While newer better treatments will require you to pay a premium. Think of car dealerships providing you health treatments.
    There is no incentive to improve the basic level of cover.

    Pivate Insurance will be offered to you to cover each grade of health care, and in this way we move to an American system of private cover as basic service is residualised for the poor and ‘undeserving’.

    The American system diverts a quite ridiculous sum of money into its health industry coffers to the harm of the economy, as an efficient profit system should do. If they could release a fraction of the money spent on their healthcare into other business areas the economic transformation would be mind blowing. (If we could have diverted a small portion of housing money into our real economy it would be mind blowing).

    This is inevitable where demand is inelastic i.e. doesnt go away. You can choose not to buy or delay purchase of a brand of TV or chocolate, but public necessities are not optional esp health care.

    this is the ideological shortcoming of the right wing.
    In tandem, your disposable income is being ravaged by a deliberate inflation policy so that banks can continue to be bailed out.
    Osbourne relies on high unemployment and low growth to keep wage rises and interest rates down and let the mountain of PRIVATE debt be inflated away (£1.5trillion, mainly housing, that stops banks lending). the deficit is a distraction for political discourse.

    This is to be a truly awful decade.

  • porkfright

    Well of course this is part of the mess we get from being ruled by democratically-elected Oxbridge-graduates-of-a-sort of any of three parties whose senior figures have never done a proper job in their lives.

  • DocKnowsBest

    “Older or less effective treatments will remain the ’standard’ nhs offering. While newer better treatments will require you to pay a premium.”

    We already have this – it is called NICE.

    I agree about the misallocation of resources into health. Also, the past record of private involvement in the NHS (as in PFIs) has been rapacious.

  • http://twitter.com/haltonbrat Christopher East

    The public have already seen this happen in the dental service started off by Thatcher. However this time they are wise to the lies and corruption in politics and simply will not accept it. Every GP surgery and hospital have these ridiculous signs saying that they do not accept abuse otherwise you will be prosecuted. Well I can see these being torn down and ripped up for a start. If they treated people as human beings rather than people who should be grateful for the “free” service they are given, then they would not be abused.

  • Expatnhappy

    I dont need to meet you, all I need to know is that you are not 100% dedicated, publicly, to do the will of your political masters. You are servants. So serve or resign.


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