Tuesday, 1 February 2011

Red Dolphin's response to the Health Reforms (2): Quis custodiet ipsos custodes?

The idea of de-politicising the NHS if of course attractive. Removing it from the short-termism of the past, with politicians creating sub-5-year milestones that enable them to massage the data into their re-electability is clearly not a sensible way to form strategy for a country's health service, where the term of a parliament is but the blink of an eye. Under the new reforms Monitor, the independent Foundation Trust regulator, will be given far more powers. It behoves us therefore to scrutinize this body closely and ask: is it able to perform this extraordinarily delicate and vital task, and also - who guards the guards?
Remember that this watchdog had the responsibility to ensure that all Trusts are able to stand firmly on their own financial feet but under the new Bill it receives a far wider mandate to include licensing providers, price setting, promoting competition and supporting service continuity. This is from it's own website.
But wait one moment. 'Promoting competition' and 'supporting service continuity'? Is it just me or is that a contradiction in terms. Let us just imagine for a moment...
Let us say that a hospital is offering a diagnostic service that is an integral part of a pathway for patients with a variety of conditions. The result is fed into the body of knowledge that is accumulating on the patient and reviewed in a specialist clinic or multi-disciplinary team meeting. Now consider that a private consortium - hospital, independent diagnostic centre or consortium of private providers - offers to undercut the tariff that the hospital charges for this test and wins a contract to perform a fixed number of these per year. However, being outside the organisation the results are not so easily available; they may not find their way to the patient record in time, or at all. The patient's treatment is delayed; the test might even need to be repeated. A pessimistic scenario? Not at all: a regular occurrence since the introduction of the Independent Sector Treatment Centres some years ago.
So how does one square the circle of promoting this competition yet supporting service continuity? Clearly having some experienced medical input into these decisions would help identify such retrograde steps. But one look at the Board and Senior Management Team of Monitor reveals a local government officer, three management consultants, a venture capitalist, two accountants, a lawyer, an HR professional and an administrator at the top table. Not a medic in sight.
So who guards the guards?
No one who might know anything useful.

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