Wednesday, September 10, 2008
When radicalism meets reality?
2:01 pm gmt
I was struck this week by the relationship between two separate reports - one from Reform, looking at models of health
funding and the other from the King's Fund looking at the reality of current expenditure patterns on specific diseases.
It'll come as no surprise to most readers here that spending patterns vary hugely, even after accounting for what we
know about local needs (a factor of almost 3 separates the highest and lowest spending PCTs on Mental Health after making
adjustments for need). As the report says, this doesnt yet translate to an analysis of expenditure according to outcome
(true Value for Money), but they suggest that is coming (I wont hold my breath).
So it was interesting to see that report juxtaposed with the Reform piece. This piece (co-authored by Profs Nick
Bosanquet and Karol Sikora) argues for a move to a 'Health Protection' base and insurance for all (with top-ups eg for high
costs drugs), and is clearly an entry in the debate about co-funding (some of you will have heard Prof Sikora on the Today
programme last week on just this last topic).
What this doesnt do for me is deal with the central question of why spending varies so much from one area to another,
with variations that could easily accommodate the sort of expenditure Prof Sikora wants to see on currently 'rationed' drugs
(ie those not yet approved by NICE).
So, if the Reform piece is 'just' a polemic as one commentator opined, should we simply dismiss it? Again for me
the answer is 'no'. We sometimes get so caught up in the justification of what is now that we forget that
other schemes of thinking and offering services can have real benefits, and that they can address such fundamental concerns
as huge and unexplained variations in expenditure.
The debate about co-funding may be an anathema to many healthcare professionals, but we stop thinking about what we are
doing at our peril (and the peril of those we serve).
Monday, July 21, 2008
3:07 pm gmt
Keeping the momentum going over the summer has always been difficult -people just aren't available, just as the cycle
in the financial year moves from early stages planning to full-scale implementation, the heat seems to affect the way people
think and act...And wouldnt it make sense to wait for the promised response from X (the DH?), Y (the SHA?) or Z (the
Despite everyone's attempts this cycle repeats - this year the national procurement of World Class Commissioning support
creates a classic planning vacuum, and 3 year planning cycles dont seem to make that much difference to when favoured projects
actually kick off.
Familiar? But it doesnt have to be so and not just because there's not much sign of a heatwave! IMHO it takes a
combination of forward-planning, a little risk-taking (working at risk) and the right attitudes. The first is perhaps
the most obvious - nothing more than good project management. The others are a deal more complex. Do you have a
solution to these, are there other factors I've missed? In either case I'd love to hear from you, but these are also areas
where I have inputs to offer :-) !
And whatever you are up to, have a good summer!
Monday, June 30, 2008
No time for Cynicism
2:12 pm gmt
Listening to today's announcements (online) from Ara Darzi and the clinical SHA leads there was no place for cynicism.
In the past I've worried that medical leadership issues would get in the way of delivering real change in the NHS (see the
item I wrote last autumn in Thinking for Doing
What's impressive for me is the practicality of the speakers' recommendations. And the sense they have been part
of something that has significantly shifted the ground. I saw some of that happening in recent work with a health community's
clinicians, managers and public coming togther to make real progress on otherwise intractible issues.
My worries cannot be removed overnight - is this just the usual suspects, how can this be brought to bear with
others, how many have found the process too much? Yet these are issues which can be addressed if the spirit and will
Today's announcements showed me that this does have the potential to be deliverable. That's a huge step forward.
Tuesday, June 17, 2008
What are you thinking about?
10:38 am gmt
Sometimes I write down what I am thinking about, and some of those thoughts are here on this web-site (Click here
to see some examples). Do they get you thinking?
I'd be really interested to learn what you are thinking about - whether it is leadership, change, the state of the NHS,
medics as leaders - whatever....
I'm writing a piece on 'how the NHS thinks', so if you are interested on what are the prevailing mindsets or fliters
through which the NHS sees the world and itself, let me know your thoughts here - or write to me...