In the week that the NHS Commissioning Board Authority unveiled and approved its proposed structural design, comment has been split between those castigating its bloated costs and those fearing that management cuts will adversely affect patient care. According to the Board’s own figures, management costs will be halved, in part through the wonders of matrix working. Its success remains to be seen.
Elsewhere in the NHS, moves to drive down management costs are widespread. CCG management allowances per head of population have been similarly meagre, hinting that CCGs will need greater scale to be able to function economically. This could either be achieved through mergers or by reliance on the 40 or so Commissioning Support Organisations being helpfully established by the NHSCB out of the remnants of the PCTs.
One area of management cost that the reforms don’t recognise, for obvious reasons, is the cost incurred by the purchaser-provider split. The split has enabled something of a provider market to operate, injecting competition into the heath service to improve service provision. It has also helped the NHS realise many costs which were historically hidden to view. Yet the policy has also had some less beneficial consequences.
For example, the split creates an unconvincing dichotomy between ‘purchasers’ and ‘providers’ in the NHS, with both sides seeking the best deal from each other. In the zero-sum context of a taxpayer-funded health service, where a loss for either side of the split is ultimately a loss for all, the purchaser-provider split may simply have the consequence of driving management costs higher while shifting problems between commissioners and service providers
The jury is out on whether the split has been successful in driving up standards of care compared to other parts of the UK. With such a focus on management costs in the reformed NHS, it seems inevitable that the debate on the purchaser-provider split will open up once more.
- February 7, 2012 posted by Andrew Wilkinson | Permalink
