1. October 2004 05:00
This article is the second part of the analysis of the Politics of Health, following on from last month. The alignment agendas can be summarised as Chronic Disease management (CDM-watch out for a DoH paper on this in September), health inequalities (do you have evidence to show your products work or work better in ethnic communities, the elderly?) and increased patient involvement in their health management. Other developments that may come to fruition if Labour get re-elected and should be tracked include:
- Devolved commissioning to GP practices
- Payment by results (PbR) - this is causing a lot of angst in the NHS at the moment, and may cause a lot of angst in the industry if launch strategies do not take account of its impact. It will shift the commissioner agenda to quality not cost, whilst making NHS Trusts highly cautious of initiating new drugs – particularly specialist hospital only drugs – unless they can show demonstrable quality/capacity improvements for their extra cost
- Regulation: the new Healthcare Commission has much more aggressive leadership under Prof Sir Ian Kennedy and will not put up with any more excuses/game-playing around delayed implementation of NICE guidance nor PCTs that demonstrate tokenistic behaviour with the patient participation agenda. The new HCC has already criticised 2 PCTs for poor patient involvement in the implementation of the CHD NSF agenda
- Choice will expand beyond choice of hospital and no doubt include patient choice in medicine taking - expect to see patients views listened to much more carefully by formulary/medicines management committees
- Diversity of supply: pilots by PCTs working with US Health Management Organisations, Kaiser and Evercare, to improve chronic disease management are in full flight.
- Pfizer are demonstrating the scope of diversity of supply with their CDM initiative in one of the large London PCTs
- PCT mergers to realise economies of scale - interesting this one, as some PCTs become as large as the HAs they originally replaced.
But you won’t have to wait until the next General Election to see some of the more traditional Labour behaviours emerge. The Health Select Committee has announced its intention to commence an inquiry into the pharmaceutical industry in September 2004. The inquiry will be far-reaching and will focus on:
- Drug innovation
- The conduct of medical research
- The provision of drug information and promotion
- Professional and patient education
- Regulatory review of drug safety and efficacy
- Product evaluation, including assessments of value for money
The Committee will be taking a very close look at the influence of the industry on organisations such as NICE as well as prescribers, professional and academic institutions. Those who support the conspirators view of the world suggest that this is a “parting present” to its Chairman and Wakefield MP, David Hinchcliffe, who has always kept a close eye on the behaviour of the pharmaceutical industry. Watch this space, the Health Select committee will leave few stones unturned and the media will have a field day if it digs up anything even slightly questionable. So what about the Tory plans for health? At the moment they are high on rhetoric and light on detail, wrapped up in a speech to the NHS Confederation on July 6th 2004, by the Shadow Health SoS, Andrew Lansley. Patient choice, medical staff free from bureaucracy and waiting lists a thing of the past was the rhetoric. Oliver Letwin, the Shadow Chancellor, has a real bee in his bonnet about the “Big government” and the growth of the civil service, pledging a further reduction in the size of the DoH and NHS quangos. GPs will be able to spend the £1.7bn savings that this generates on sending patients to any hospital-NHS or private. Now, where have I seen that policy before? “Plus ca change….” Sorry Oli, difficult to see where Labour’s policies stop and yours start. The most tangible detail in the Conservative’s pledge to “reform frontline public services” being plans to abolish SHAs, devolve their functions to PCTs, who in turn would devolve their commissioning (except emergency care) functions to GPs. So, under a Conservative administration, it could be re-arrange the deck-chairs time again, without any hard measures on improving health outcomes. Still maybe the long summer recess will have helped firm up this missing link in Conservative health policy. The big issues to watch have already been covered, so I will leave you with this parting thought, because after all a year is a long time in politics – Teflon melts at 609 degrees Fahrenheit, so long as Tony’s non-stick talents stay below this not even their decline in grass roots membership will get in the way of a 3rd Labour term. As to a 3rd Blair term? Maybe “Mandy’s” new European post is really just all about creating a President Tony?
References/Further Reading 1. Mori Opinion Poll; The Independent on Sunday. 1.8.04 2. The Daily Telegraph; 2.8.04 3. The NHS Improvement Plan: Putting People at the Heart of Public Services. June 2004 4. National standards, Local Action: Health and Social Care Planning Framework 2005-2008 5. New Statesman, 16 February 2004 6. The Healthcare Commission
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