Policy led budgeting
|
|
Budgeting for the NHS needs to be changed. The present approach is an unstable muddle of conflicting policies, with inconsistencies both at commissioner and provider levels. The underlying illusion is that there are spare resources that can be deployed to various political initiatives. The reality is that in most parts of the country patient care is being cut, waiting time for elective care is lengthening, and expensive new drugs, which may be more effective than previous treatments or indeed the only hope of saving life, are arbitrarily rationed. The new approach to budgeting should commit to provide sufficient resources to comply with published policies. In the event of extra resources being available, they could be allocated to new initiatives, but not to the detriment of mainstream services. Provider bodiesBudgets should recognise that there are sufficient reasons why the costs per patient with the same condition are not uniform. These include:
A national tariff cannot accommodate such variations and is only suitable for purposes such as evaluating the relatively small number of patients treated outside their home areas. For regional specialties a special tariff recognising actual costs of the specialist unit may be needed. The budgets of provider bodies should include the committed costs. Where the costs are high, that should inform medium term policy decisions, such as to reduce the need for transport between sites, to avoid using hospitals in areas with high staffing costs for patients from other areas, and to avoid acquiring premises through expensive long term contracts. The treatments provided are a combined effect of professional judgment and policy decisions. If the maximum waiting time for elective surgery is a few months, for a cancer consultation a few days and for waiting in Accident and Emergency a few hours, and the drugs and treatments to be used are based on advice from the National Institute for Health and Clinical Excellence, both the number of patients and the cost of treatment are largely outside the provider's control. The budget should involve forecasting the number of patients (based on published policies) and estimating the number and cost of staff and supplies needed. The budget should be adjusted for numbers of patients travelling to or from their local area for treatment. This would mainly be to provide for regional specialties, but would also accommodate individual choice. Providing bodies should not be expected or allowed to charge for services, with limited exceptions (such as visitors' or out-patients' meals). Commissioning bodiesThe role of commissioning bodies should be reduced, as much of their current activity in practice is expensive and bureaucratic denial of treatment that amounts to postcode prescribing. Their essential role is formulating and deciding policy, such as the extent of services to be provided in community hospitals and GP surgeries, new developments and closure of premises. The separate commissioning (or policy making) budget should only need to be small. Our policy is that the local policy making bodies should be democratically elected. In the context of that policy the cost of the bodies should be met from local taxes. Local taxes would also pay for policies beyond national standards, such as subsidised transport to hospital for visitors or for patients who would not qualify for assistance under national standards. |
|
Sheila
Porter-Williams |