News
NHS reforms unlikely to succeed, says former government adviser
28 April 2008
The government’s plans to develop ‘world class commissioning’ in the
NHS are unlikely to be realised, according to a new report from the
Health Services Management Centre at the University of Birmingham.
The NHS reforms are centred on separating the roles of healthcare
providers and organisations that purchase or ‘commission’ care from
providers.
The report, Health Care Commissioning in the International
Context: Lessons from Experience and Evidence, reviews experience in
Europe, New Zealand and the United States.
It shows that in none of these systems is commissioning done
consistently well. A clear lesson from international experience is the
difficulty involved in commissioning healthcare services, whichever
country is examined
The report’s author, Professor Chris Ham, formerly Director of the
Strategy Unit in the Department of Health, comments: "This review shows
that the government faces huge obstacles in developing world-class
commissioning. The success of the reforms depends critically on the
commissioners of healthcare being able to negotiate on equal terms with
providers.
"However, there are challenges relating to providers effectively
having a local monopoly for certain services, and the fact that
delivering healthcare always relies on the professional judgement and
expertise of clinicians."
The research on which the report is based shows how hard it is to
address these challenges. Chris Ham adds: "Commissioners in the NHS need
to be much stronger than has been the case to date if they are bring
about improvements in performance for patients. This means investing
resources in hiring experts with relevant skills on a scale much bigger
than the government has hitherto contemplated."
The evidence in the report also shows that the success of
commissioning in the NHS depends on other elements in the government’s
reform programme. This includes giving healthcare providers greater
autonomy and the ability to respond rapidly to changing market
conditions. It also means ensuring that the right incentives and payment
systems are in place.
Chris Ham adds: "Even if world-class commissioning is developed — and
this is highly unlikely — it may fall short of its potential in the
absence of other changes in the healthcare system."
One alternative would be to develop systems that bring those who
provide and those who plan and purchase services more closely together.
"International evidence shows that these integrated delivery systems
perform better than systems where the roles of commissioner and
providers are separated.
The Darzi review, which is looking at the next stage of NHS reform,
needs to recognise the value of these systems and find ways of
encouraging their development in the NHS to build on the progress made
to date in improving care to patients.”
Further information
The report, Health Care Commissioning in the International
Context: Lessons from Experience and Evidence, can be downloaded
from:
www.hsmc.bham.ac.uk/
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