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MPs call for review of ‘fragmented’ commissioning

Future of health and care system must not depend on ‘open-ended pay freeze’

Louise Prime

Wednesday, 12 February 2014

MPs have called this morning for a review of ‘fragmented commissioning structures’ and a realistic approach to service integration, and insist that an ‘open-ended pay freeze’ must not form the foundation of the health and care system. In the Health Committee report Public expenditure on health and social care, they protest that NHS care has still not been transformed into a system that can cope sustainably with future demands. They conclude that short cuts to cost savings in the NHS over the past two years might be unsustainable, and that it’s unclear where the money saved has been spent.

Although the Committee welcomed the Government’s current emphasis on service integration, both within the NHS and between health and social care, it warned that “fragmented commissioning structures significantly inhibit the growth of truly integrated services”, and reiterated its earlier recommendations that “Health and Wellbeing Boards should be encouraged to develop their role to provide an integrated commissioners’ view of the transformative change which is necessary in our health and care system”. It called for NHS England and the Local Government Association to commission a review to ascertain the best practice method of consolidating the commissioning process through HWBs with minimum disruption of ongoing activity.

The committee complained that it was “simply dishonest” to advocate service integration without acknowledging that this necessitates reconfiguration of acute services. MPs said: “The case for acute service reconfiguration is often presented as an economic necessity, but that is only half the story … Our system currently places insufficient emphasis on identifying early symptoms and supporting normal life, with the result that it has provided reactive acute care to patients whose condition should never have been allowed to become acute.”

But the Nuffield Trust’s chief executive Andy McKeon warned against the assumption that integration would cut costs. He said: “Better joined-up care may well improve the experience and quality of life of patients, but it probably won’t create savings, certainly not in the short term. It has been suggested that changes like these will save money by keeping people out of hospitals. But our research on many ‘integrated care’ initiatives designed to achieve this has found no evidence of lower costs.”

MPs also insisted that in order to deliver high quality care, the NHS must be a good employer and “the future of the health and care system cannot be built on an open-ended pay freeze … it needs to undertake transformative change in order to ensure that its committed staff are better able to meet the needs of users of its services.”

BMA Council chair Dr Mark Porter responded: “We have seen real terms cuts to pay for the vast majority of doctors, dressed up as efficiency savings. It is no wonder that despite doctors working harder than ever before and with productivity across the NHS going up, doctors’ morale is going down.”

He added: “While we all know that health providers face year-on-year cuts, the continued erosion of doctors’ pay as the main tool to cope with increasing demand has only highlighted the Government’s failure to find a meaningful and sustainable solution to the funding crisis facing the NHS.”

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