Resources
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In April 2002 the Wanless final report recommended sustained growth in resources for the NHS over twenty years, including the highest growth rate in financial resources over the first five years as would be possible without hitting constraints on availability of trained people and physical resources. The Chancellor in his budget speech announced the Government's acceptance of these recommendations. It is still necessary to ensure that the resources are used in accordance with the public interest. This is not just a matter of efficiency, but also one of values. Professional bodies tend to promote their own profession and to seek what is professionally best, such as a best hospital or a best orthopaedic department. These approaches may not be in the public interest if they involve excluding potential patients because they cannot reach the best hospital or because the surgeons turn away potential patients who would be likely to make the department's performance statistics look worse. The need for democratic accountability and local democratic control is as great as ever. NICE is an important mechanism for ensuring accountability in decisions over which treatments will be used, although it has faults of delays and methodology. It probably gives inadequate weight to perceptible improvements in quality of life for drugs, such as Alzheimer's disease, that do not increase life expectancy but are not particularly expensive. Its scoring of "quality adjusted additional life expectancy" on a scale valuing years either at half or full value is probably too crude for a drug that only increases quality of life. Government proposals to fund services through charges rather than taxation should be resisted, even if the charges do not fall directly on individuals. The long-standing arrangements to recover cots of treating road accident victims from insurers indirectly raise motor insurance premiums. The proposal in September 2002 to charge employers for treating people injured at work will push up employer's liability premiums. If there is any need to raise extra revenue from these sources, it can be done with less bureaucracy by increasing insurance premium tax and/or employers' national insurance contributions. A policy of consistently funding the NHS through taxation would also take away any perverse incentive for hospitals to prioritise work that could be funded through charges. There are numerous examples of illegal charges for nursing care in private nursing homes, where the law states that a person whose primary need is for health care who is placed in nursing home accommodation is entitled to the NHS meeting the full cost of the package. See www.NHSCare.info "Your right to 100% NHS funded Continuing Care under UK law and the Coughlan case" and http://news.bbc.co.uk/1/hi/programmes/panorama/5196242.stm. See also Telegraph 4 March 2006 , and Monday March 20, 2006 The Guardian (the Government seeking to reduce the scope of continuing care). Hospitals funded through PFI are clearly unaffordable. This is illustrated by the University Hospital Coventry and Warwickshire, funded through PFI, which was fully open for most of 2006/07. While the Hospital Trust moved from break even in 2005/06 to an insignificant surplus of £0.1m, the Coventry and Warwickshire PCTs increased their aggregate deficits from £3.2m to £14.4m according to annex 5 of NHS financial performance 4th quarter 2006 07 DH_075228 (pdf). A complication is that the other Warwickshire hospital trusts (which provide about a third by value of the hospital services in Coventry and Warwickshire) moved from an aggregate deficit of £21.1m to an aggregate surplus of £1.5m, but this was associated with severe cutbacks in services. Government policy of incentivising private providers to increase throughput at high unit costs while under-resourcing hospitals and PCTs so that the hospitals have to reduce throughput to stay within budget is not a good use of resources, certainly in the short term. There is little evidence that the longer term implications for the accessibility of NHS services and for sustainable training of medical and other staff have been fully thought through. The separation of commissioning and provision of services is an expensive way of easing unnecessary access to NHS money by the private sector and creates financial problems and hasty decisions at the level of individual NHS bodies that may be reduced or eliminated if the accounts of the NHS bodies serving a locality are consolidated. It also leads to inconsistent policies or "postcode prescribing". Problems of slow reporting by the National Institute for Health and Clinical Excellence (NICE) seem partly to be due to misguided budget cuts, but it is important that appropriate national policies of approved treatments are proposed promptly, properly debated, and implemented nationally. It would be a bizarre way of implementing the patient choice policy for patients to be able to go to any hospital in the country, but only if the treatment complies with policies that differ between localities. Budgeting is a muddle. Funds provided with government backing to support decisions made in good faith to provide hospitals through expensive long term contracts by the Private Finance Initiative are arbitrarily withdrawn as they do not fit later initiatives such as money following the patient, but no alternative source of finance is available. The numerous examples of postcode prescribing, apart from making a mockery of patient choice, demonstrate that primary care trusts are not resourced to support consistent policies. See our proposals for policy led budgeting. |