Stuart Carroll and Gary Jones: If fortune favours the brave, the Government's NHS White Paper makes the right noises and is to be commended

Gary Jones is a member of the Bow Group Health Policy Committee and a public affairs consultant. Stuart Carroll is a senior health economist and chairman of the Bow Group Health Committee. Here they summarise the research paper they have written for the Bow Group on the Government's recent NHS White Paper, which is published today and can be downloaded here.

The Coalition Government’s NHS White Paper represents the most radical Government Health White Paper since the creation of the NHS in 1948. Whilst the White Paper signals relatively few changes in the patient facing end of the health service, the proposals to introduce GP consortia to carry out the bulk of NHS commissioning constitutes a radical and bold step.

These courageous plans have great potential to bring primary care closer to patients with a stronger focus on prevention. However, the smooth and effective implementation of this policy will be necessarily dependent on the removal of a number of practical barriers and strong leadership across the 1.3m people making up the world’s fourth largest organisation.

The Bow Group has today published new analysis on the White Paper, which outlines our considered response to Equity and Excellence: Liberating the NHS – the Health White Paper setting out the Government's long-term vision for the future of the NHS in England.

The analysis focuses on five key areas, which feature prominently in the White Paper. These include 1) GP commissioning, 2) Quality and outcomes, 3) Public health and prevention, 4) Efficiency savings and Quangos, and 5) Value and innovation. Here we summaries the main points from our analysis. 

1. The GP Commissioning Revolution
The most significant and ambitious proposals set out in the White Paper are plans that will see the creation of GP consortia to take on the role of GP commissioning. Consortia will take over commissioning for the majority of NHS services.  It should be recognised that the “commissioning revolution” offers great potential to drive up clinical standards and improve productivity across the NHS.  It is widely considered that PCT commissioning has been a disappointment in recent years and has failed to deliver its potential.  In April 2010, the cross party Health Committee published its report on commissioning concluding that PCTs are not commissioning effectively enough and that they often lack the “clinical knowledge” to challenge hospitals over the provision of services.

It is clear that enhanced GP commissioning represents an opportunity for positive change.  However, this radical reform confers a number of practical barriers, which the Government will need to be overcome.  This is not least the case when demonstrating to the public, and the healthcare system as a whole, that the devolution of around £80 billon of NHS resource is a wise move with previous funds being spent efficiently and effectively. In addition, it is not clear how GPs will share the risks and rewards of their enhanced roles. 

It is likely that many GPs will anticipate benefiting financially from the new model as they acquire new responsibilities. It will be essential that the Government sets out a clear framework to ensure that there are robust rules on transparency and accountability so that everyone involved – GPs, PCTs, hospitals, contracted companies – know exactly where they stand, and most importantly, remain directly accountable to patients.

Gary Jones is a member of the Bow Group Health Policy Committee and a public affairs consultant. Stuart Carroll is a senior health economist and chairman of the Bow Group Health Committee. Here they summarise the research paper they have written for the Bow Group on the Government's recent NHS White Paper, which is published today and can be downloaded here.

The Coalition Government’s NHS White Paper represents the most radical Government Health White Paper since the creation of the NHS in 1948. Whilst the White Paper signals relatively few changes in the patient facing end of the health service, the proposals to introduce GP consortia to carry out the bulk of NHS commissioning constitutes a radical and bold step.

These courageous plans have great potential to bring primary care closer to patients with a stronger focus on prevention. However, the smooth and effective implementation of this policy will be necessarily dependent on the removal of a number of practical barriers and strong leadership across the 1.3m people making up the world’s fourth largest organisation.

The Bow Group has today published new analysis on the White Paper, which outlines our considered response to Equity and Excellence: Liberating the NHS – the Health White Paper setting out the Government's long-term vision for the future of the NHS in England.

The analysis focuses on five key areas, which feature prominently in the White Paper. These include 1) GP commissioning, 2) Quality and outcomes, 3) Public health and prevention, 4) Efficiency savings and Quangos, and 5) Value and innovation. Here we summaries the main points from our analysis. 

1. The GP Commissioning Revolution
The most significant and ambitious proposals set out in the White Paper are plans that will see the creation of GP consortia to take on the role of GP commissioning. Consortia will take over commissioning for the majority of NHS services.  It should be recognised that the “commissioning revolution” offers great potential to drive up clinical standards and improve productivity across the NHS.  It is widely considered that PCT commissioning has been a disappointment in recent years and has failed to deliver its potential.  In April 2010, the cross party Health Committee published its report on commissioning concluding that PCTs are not commissioning effectively enough and that they often lack the “clinical knowledge” to challenge hospitals over the provision of services.

It is clear that enhanced GP commissioning represents an opportunity for positive change.  However, this radical reform confers a number of practical barriers, which the Government will need to be overcome.  This is not least the case when demonstrating to the public, and the healthcare system as a whole, that the devolution of around £80 billon of NHS resource is a wise move with previous funds being spent efficiently and effectively. In addition, it is not clear how GPs will share the risks and rewards of their enhanced roles. 

It is likely that many GPs will anticipate benefiting financially from the new model as they acquire new responsibilities. It will be essential that the Government sets out a clear framework to ensure that there are robust rules on transparency and accountability so that everyone involved – GPs, PCTs, hospitals, contracted companies – know exactly where they stand, and most importantly, remain directly accountable to patients.

Gary Jones and Stuart Carroll: GPs' pay should be linked to patient outcomes

Gary Jones is a member of the Bow Group Health Policy Committee which is chaired by Stuart Carroll, a senior health economist and Policy Analyst. Here they summarise the research paper they have written with Jennifer White for the Bow Group on the Quality and Outcomes Framework (QOF), which is published today and can be downloaded here.

Launching the recent Conservative Draft Health Manifesto, Shadow Health Secretary Andrew Lansley recognised the current problems in the NHS, noting that under Labour, health inequalities have widened and public health problems, such as obesity and alcohol abuse, are increasing at soaring rates. The role of GPs in tackling these problems must not be underestimated. GPs are normally the first point of medical contact within the NHS and they play a vital role in preventive care, which typically involves diagnostic screening and providing advice on how to lead a healthy lifestyle.

A key part of Labour’s vision has been to empower GPs to improve both patient health outcomes and tackle inequalities. One of the key mechanisms for this vision was the Quality and Outcomes Framework (QOF) – a voluntary incentive scheme for GP practices in the UK that rewards doctors based on the quality of care delivered to patients. The QOF was launched in April 2004 and under this framework GPs are rewarded for implementing "good practice" in their surgeries. The framework is designed to remunerate general practices for providing good quality care to their patients and to help fund work to further improve the quality of health care delivered. 

In our research published today, we evaluate the progress the QOF has made since its introduction and consider the different ways in which the QOF can be reformed to be more effective.  Overall, it is fair to say that the QOF has been a relative success in supporting the drive to increase the standard of care, but there is strong evidence that standards have tailed off in recent years.

We have found that the problems and shortcomings currently informing the QOF are not so much a consequence of its philosophical purpose, but rather the practical elements determining its operational functioning. We believe that a key consideration for policymakers moving forward should be to look at how the QOF can be improved and reformed to better achieve its stated objectives.  Although the QOF in itself is not a vote-winner and is unlikely to register on the public’s political radar, it has the potential to facilitate the outcomes-driven health service the public wants to see and in turn is a potentially important piece of the NHS jigsaw.

Stuart Carroll: How David Cameron should go about reforming the NHS quangos

Stuart Carroll is a senior health economist and Policy Analyst who chairs the Bow Group's Health Policy Committee. Here he summarises the new research paper he has co-authored for the Bow Group, "People Power: Reforming QUANGOs – Is this Applicable to Health Agencies?", which is published today and can be downloaded here.

In July 2009 in a speech to Reform, David Cameron made the unequivocal statement that “we do need to reduce the number of QUANGOs in this country” to increase public accountability and save taxpayers’ money.  Although the Conservative Party leader made it clear that it would be far too “simplistic” to propose a “bonfire of the QUANGOs”, he emphasised his strong appetite for significant reform of these organisations and a general rolling back of unelected governmental bodies.  Indeed, on the back of this speech Mr. Cameron asked his Shadow Cabinet to review every QUANGO within their respective policy briefs in a process continuing “up to and beyond the general election”.  

Given that the Conservative Party has pledged to ring-fence the NHS budget and is committed to real terms spending increases as way of number one policy priority, it is an important question to ponder as to which health QUANGOs could and should be scrapped; reduced in scope and size; reformed and renewed; or merged.  This is not least the case given the continual push for better healthcare service deliverability and efficiency; the parlous state of the public finances and associated recessionary pressures on NHS spending; and the wide-ranging number of health agencies that currently exist.   

In the same Reform speech, David Cameron set out the following questions that his Shadow Cabinet will have to ask when undertaking their QUANGO review:  

• Does this organisation need to exist?
• If its functions are necessary, which of them should be carried out in a directly accountable way within the department? 
• And which, if any, should be carried out independently, at arm’s length from political influence? 
• If there really is a need for an independent QUANGO, how can we make sure it is as small as possible, operating with maximum efficiency, frugality and respect for taxpayers’ money?

In our research published today, we apply Mr. Cameron’s criteria to each of the key health agencies and bodies in the UK to better understand which health QUANGOs (defined as agencies, committees, advisory boards and other organisations) should be scrapped, reformed or merged.

Stuart Carroll is a senior health economist and Policy Analyst who chairs the Bow Group's Health Policy Committee. Here he summarises the new research paper he has co-authored for the Bow Group, "People Power: Reforming QUANGOs – Is this Applicable to Health Agencies?", which is published today and can be downloaded here.

In July 2009 in a speech to Reform, David Cameron made the unequivocal statement that “we do need to reduce the number of QUANGOs in this country” to increase public accountability and save taxpayers’ money.  Although the Conservative Party leader made it clear that it would be far too “simplistic” to propose a “bonfire of the QUANGOs”, he emphasised his strong appetite for significant reform of these organisations and a general rolling back of unelected governmental bodies.  Indeed, on the back of this speech Mr. Cameron asked his Shadow Cabinet to review every QUANGO within their respective policy briefs in a process continuing “up to and beyond the general election”.  

Given that the Conservative Party has pledged to ring-fence the NHS budget and is committed to real terms spending increases as way of number one policy priority, it is an important question to ponder as to which health QUANGOs could and should be scrapped; reduced in scope and size; reformed and renewed; or merged.  This is not least the case given the continual push for better healthcare service deliverability and efficiency; the parlous state of the public finances and associated recessionary pressures on NHS spending; and the wide-ranging number of health agencies that currently exist.   

In the same Reform speech, David Cameron set out the following questions that his Shadow Cabinet will have to ask when undertaking their QUANGO review:  

• Does this organisation need to exist?
• If its functions are necessary, which of them should be carried out in a directly accountable way within the department? 
• And which, if any, should be carried out independently, at arm’s length from political influence? 
• If there really is a need for an independent QUANGO, how can we make sure it is as small as possible, operating with maximum efficiency, frugality and respect for taxpayers’ money?

In our research published today, we apply Mr. Cameron’s criteria to each of the key health agencies and bodies in the UK to better understand which health QUANGOs (defined as agencies, committees, advisory boards and other organisations) should be scrapped, reformed or merged.

Stuart Carroll: The NHS Postcode Lottery – It Could Be You

Stuart Carroll is a senior health economist, policy advisor and researcher for the Bow Group. Here he summarises the research paper he has co-authored for the Bow Group on the NHS Postcode Lottery which is published today and can be downloaded here.

The National Health Service is the number one priority for David Cameron’s Conservatives.  A key policy challenge concerns access to services as based on need.  As my research paper (co-authored with brother Ross) just published by the Bow Group shows, access is often not based on need due to the persistence of the “postcode lottery” – random countrywide variations in the provision, delivery and quality of healthcare services.

Contrary to government rhetoric, where you live remains a major determinant of the healthcare you receive.  There are geographical variations in virtually all aspects of healthcare, including charges for patient home care, waiting times, and diagnostic screening.

Our research reveals three key areas where the postcode lottery is particularly prominent and problematic:  1) the implementation of National Institute for Health and Clinical Excellence (NICE) guidance; 2) access to life-saving drugs and treatments; and, 3) the provision of end of life care.