The joys of policy analysis mean the NHS Operating Framework is obligatory reading. 'Grip' is its message, no surprises there. But tucked in amongst the pages four things caught my eye.
Para 3.29 requires commissioners to link patient NHS numbers to contractual payments by March 2013. By then, it should be possible to identify routinely how much NHS expenditure goes on each individual – a crucial milestone to identify efficiencies. My bet is on information to give the NHS the biggest lift over the coming decade.
The second was para 4.24 – in response to concerns about "cherry picking" commissioners will be allowed to adjust the tariff price if the type of patients that a provider treats results in lower costs than the average for the tariff category. Perhaps this para was designed with Independent Sector Treatment Centres (ISTCs) in mind who are accepting less complex cases than the NHS (although offering at least as good care).
But my mind wandered to the current opaque area of NHS policy on price flexibility. Could not commissioners use the presumed innocent para 4.24 to start negotiating price reductions? And what of David Nicholson's suggestion to one of the House Committees last year that price flexibilities should be accompanied by trusts supplying greater information on quality of care (to help reduce skimping)? No mention of that in the Operating Framework.
The third thing to catch my eye was mention of integrated care in the very first paragraph, which is some triumph after its absence in the original Equity and Excellence White Paper. We've been tracking progress in Trafford which shows you the long haul in store, even with committed staff and £2m investment. That is, without more radical freedoms and incentives – which make for tricky partners with 'grip'. More on this in early 2012.
The fourth was the stated value of risk stratification in helping identify patients at high risk of hospitalisation. Our analysis: Choosing a predictive risk model: a guide for commissioners in England may help here.
I note the size of populations covered by the shadow clinical commissioning groups (CCGs) – a healthy 93k to 1.3m. All then a reasonable size to manage most unpredictable financial risks. Our analysis on developing a needs-based predictive formula for allocating resources to commissioning practices shows that practices are too small to take on much risk – clearly a job for the NHS Commissioning Board (now NHS England) to advise CCGs in this area, if practices are to hold budgets.
The hunt is on for any intervention to reduce avoidable emergency hospitalisations. Answers on a postcard would help. We will report later on telehealth/telecare and virtual wards. But in the meantime read more about the lessons from the virtual ward model deployed in Toronto.
Finally, is anyone else bothered by all the changes proposed for public health? I have in mind the third tribe: the first being those in health protection/communicable disease control and moving to Public Health England; the second being those interested in the wider determinants of health and moving to local authorities; and the third being the minority interested in health services research and quality of NHS care.
The latter were championed by Sir Donald Acheson in his landmark report in 1991. But what home for them?
Dixon J (2011) ‘Is data the new hero of the NHS story?’. Nuffield Trust comment, 30 November 2011. https://www.nuffieldtrust.org.uk/news-item/is-data-the-new-hero-of-the-nhs-story