As suggested by Lord Rennard in his comment to the Baroness Jolly piece on Lib Dem Voice yesterday I went through every amendment to the Health & Social Care Bill yesterday. I have a huge amount of respect for Chris and so I felt it was important I did so.
There was one change I hadn't properly recognised - I think it may have been changed on Monday night, maybe I just kept missing it. Ironically it's one of the earliest amendments. It does now seem clear to me that the total and final responsibility for Public Health and the NHS does now lie once again with the Secretary of State. There was wiggle room before. So one of my detailed concerns with the bill has been allayed.
However one of my other concerns still remain. I still cannot find a detailed and explicit clause where CCGs are mandated to put quality above price. I have seen reference that price cannot be put before quality - but that is different, it implies equality of these two factors, not superiority of one over the other.
I would be happy to be wrong about this. I may just be missing it - there is a lot to get through and cross referencing amendments with the bill gets complicated. Indeed the BBC news also explicitly stated that quality has primacy over price in the Act.
So if anyone can point me to the exact point where this is written into law I will be obliged and feel better.
My main objections to this bill remain. The electorate were told no massive reorganisation of the NHS - they have got the opposite. The professional bodies representing medical staff in the NHS predict chaos. I fear the cost savings predicted will not materialise and patient outcomes will suffer.
But I am happy to acknowledge there are good things in the bill. I am not a 'no reform under any circumstances' merchant - our manifesto called for reform (though not these ones). And if anyone can show me that quality of service over price is written in stone than I will be a (slightly) happier man.
UPDATE
As you can see below, Lord Rennard has taken up the challenge, and answered my question in full. I doff my cap in his direction. That IS what I call service!
I asked our very good researcher in the Lords health team (Chris Jenkinson) about this. He said that Tim Clement-Jones is the expert but in short the way it works is (clauses relate to the version as amended on Report in the Lords):
ReplyDelete1. Monitor produces the “national tariff” for each “health care service” provided by the NHS (clause 116)
2. Before doing so, Monitor must consult each CCG and each relevant provider, and other persons they consider appropriate, setting out how they plan to design the tariff (clause 118)
3. If a “health care service” is covered by the national tariff, a CCG may only pay the price set out in the tariff (clause 115)
So the point is effectively that there can be no competition on price for services covered by tariffs as there is no leeway to do otherwise. There is a little flexibility for local variations in price but that has to be a deal struck between the CCG and the provider and approved by Monitor.
From the bill: “Health care” means all forms of health care provided for individuals, whether relating to physical or mental health, with a reference in this Part to health care services being read accordingly. (clause 64).
So Richard’s concern (“I still cannot find a detailed and explicit clause where CCGs are mandated to put quality above price. I have seen reference that price cannot be put before quality - but that is different, it implies equality of these two factors, not superiority of one over the other.”) is met for services covered under the national tariff. For services not covered there will be other rules setting out what the price payable is exactly (this is also in clause 115).
I hope that this helps
Best wishes,
Chris
Thank you Chris - I really appreciate that and your answer is very clear. Happy to hold my hand up on that point and say I was wrong. The complexity of the answer does give me pause for thought about what else is in there I'm missing - though of course it is that very complexity which so many fear makes executing this bill very difficult.
ReplyDeleteThanks again
The difficulty is that huge parts of NHS commissioning are not covered by tariff. The proposal to stop competition by price has been falsely claimed as our victory but was dropped from the bill by the government before the committee stage of the Commons when every think tank in the land condemned it.
ReplyDeleteThe real issue is whether the private firms bent on cherry picking can engage in a loss leader approach and price their services at tariff to put local hospital services. Some with big equity backers are clearly capable of doing so. The parallel would be Tesco getting rid of local petrol stations .
The loss leader effect implies you get paid at tariff but provide far more for a while than the local hospital department to get the contract and kill off your local hospital department. Short term loss for the private provider - long term gain
ReplyDelete