01.10.10
Achieving savings in commissioning controversy
After an unparalleled period of funding and growth, the NHS is now looking to make large scale efficiencies and one of the first places to start is the commissioning process. Richard Mackillican talks to Mike Ramsden
Commissioning is a controversial subject at the best of times but even those who espouse the value of commissioning in the NHS are saying that there is room for cuts.
As a result of various government and Department of Health strategies over the years, there are now undoubtedly far more people working for PCTs than there were when the trusts were originally set up and Mike Ramsden,who is chief executive of the National Association of Primary Care, believes there is scope for greater efficiency in these areas.
Commissioners were not the first people involved in NHS procurement to be accused of wasting money. Before them, it was the process which was under fire.
“We certainly do not want to see a return to the problems of the fundholding era where the transaction costs, as a result of the commissioning process, were increasing because every fundholding practice was incurring administrative costs by virtue of all of the contracts which they were placing.
“However, we certainly see that the commissioning process still needs to be streamlined and that this has to be done by reducing spend from its current level.”
Something that the NAPC is heavily involved with is promoting the idea of practice based commissioning within the NHS.
“I feel that this is the single most effective way of changing how commissioning works and this is where we will concentrating our efforts in 2010.”
Last year’s announcement by Andy Burnham that, should Labour win the next election, the NHS will be made the preferred provider for services, makes Mike uneasy.
“We would want to see an increase in the choice of service provision so his statement was a disappointment.
“In many ways, the NAPC feels that it doesn’t matter who provides the service as long as what they are providing is of excellent quality and that we should not be so obsessed with following this kind of nationalised industry model for provision.
“We would be deeply disappointed if there was to be a restriction on the range of organisations which can be used to provide services because this kind of plurality of provision is an approach which has been developed over the last ten or more years.”
There is concern that the use of private sector companies to deliver healthcare would shift the balance of interest from patient care to turning a profit but Mike sees it rather differently.
“There are lots of example of independent sector providers,” he says. “I have had some very good experiences using services provided by the independent sector, especially in delivering services for people with learning disabilities, where the provider was able to deliver some very specialist care.
“Often small scale, independent providers have been able to respond to commissioners requirements to deliver more timely and local provision of services. This is what we want to see.”
In Mike’s mind, the real argument is not around who delivers healthcare. “It doesn’t matter who delivers the care to patients, as long as that care is publicly funded. Perhaps we need to move on and stop holding onto this vision of what the NHS was like in the past.”
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