Commissioning - Health Committee Contents


Examination of Witnesses (Questions 160 - 162)

THURSDAY 22 OCTOBER 2009

MR GARY BELFIELD, DR DAVID COLIN-THOMÉ, MR MARK BRITNELL AND MR DAVID STOUT

  Q160  Dr Taylor: Thank you very much for putting us straight. We all know we have to be careful what we say to the tabloids, but we now have to be careful what we say to the HSJ as well.

   Dr Colin-Thomé: I think the problem is maybe my inappropriateness of language.

  Chairman: We have all had our comments taken out of context one way or another.

  Q161  Dr Naysmith: Practice-based commissioning used to mean you got a little bag of money for a budget that you in practice could spend on what you liked, and it is has clearly evolved quite a lot from there on what you have been saying this morning. The other idea that Professor Bevan was throwing about and which we have discussed a bit was this idea of purchaser/commissioner competition, competition between purchasers. Do you think that is the next frontier for choice and contestability?

  Mr Stout: Not unless we are going to radically redesign the healthcare system we have. The Netherlands example that he quotes is competing insurance-based systems. We do not have anything remotely like that. Could you have that sort of system? Yes, I guess you could, but it would mean yet another fundamental reorganisation, and we have argued quite strongly that the last thing we need is a fundamental reorganisation. Theoretically there is choice, in that you have a choice of GP. As a patient, you choose your GP; your GP is making commissioning decisions every time they make clinical judgments about you. In that sense there is a degree of choice. But to move to a competing system of commissioners—as in, that you can choose which PCT or equivalent you are a member of—while theoretically possible would be an incredibly major overhaul of the healthcare system as we know it. To be honest, from what I know of the evidence of the Netherlands it is not particularly clear how effective that element of their system has been. It is relatively new. The evidence, from what I have read anyway, is not particularly strong in terms of its effectiveness. There are other strengths of the Netherlands system, but I am not sure that is one of them.

  Mr Belfield: I agree. Hidden in the middle of Gwyn Bevan's report is the point that they spent a bit of time making sure that their commissioners improved their capability first before they went to that system, and, as Mark said earlier, we are in the foothills really of getting our commissioners into good shape to do well for their population, so we are nowhere near that debate at the moment. I would like to do what we are now doing well first, please.

   Dr Colin-Thomé: I think Gwyn Bevan said there was 20 years of preparation for some of his thinking. These things take time. I think we could use what we have here better as a way forward. The Netherlands are different from us anyway in some of the way they set up their social insurance schemes. Let us use what we have and do better. This is what our process is about.

  Q162  Chairman: We are about to publish the written evidence to this inquiry in the next week or two. It is quite substantial. Much of the evidence that we had submitted to us is critical of the commissioners' specialised services, arguing that the commissioning is not joined-up enough and that Sir David Carter's Review in 2006-07 has not been implemented. What can be done to improve this situation, if indeed that evidence is right?

  Mr Belfield: I am mindful of that. I have heard that a lot. There are two things we have done. First of all, we have worked with the ten specialist commissioning groups which fell out of the Carter Review and to work with them to understand how we can help them become better commissioners. We have not—which is where some of the criticism has been—embedded the specialist commissioning groups into our assessment process, which I think is one of the things that they would like us to do. For this year we have put out a framework that is a voluntary framework where specialist commissioning groups can assess themselves in a sense, and we have said that after this year of a voluntary process we will consider with all ten specialist commissioning groups of next year about whether we then integrate it completely into our assurance process for the PCTs. One thing I would like to say though is that every PCT has the responsibility somewhere in their portfolio for commissioning specialist services. They do not discharge that responsibility; they involve the specialist care commissioning groups to do it on their behalf, but hey still have to take responsibility and accountability at a local level. Our process does look at that, but it is a fair criticism from the group—and I am pretty sure I know who sent this to you—and we will consider this year hw we can do it on a voluntary basis and then we will consider for next year whether we need to embed it into our systems or not. It is a fair criticism.

  Chairman: Okay. Thank you all very much indeed for coming along and helping us with this inquiry.






 
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