The much trumpeted draft health manifesto from the Conservatives contains a couple of interesting points. One the one hand there is the promise to:
scrap all of the politically-motivated process targets that stop health professionals doing their jobs properly, and set NHS providers free to innovate by ensuring they become autonomous Foundation Trusts
An admirable sentiment, performance targets drive behaviours and when organisations are set simplistic targets, and too many of them, it skews their delivery to meet the targets. Frequently in the NHS what we see is delivery that meets the targets regardless of whether it is in the best interest of the citizen, the Health Trust or the budget. However performance targets are the basic mechanisms of management control, without performance management nobody knows whether all the activity going on is actually useful or cost effective. So we’ll be left with a political party telling us ”it’s better, honest, would we lie to you?”
So what we’re going to get will be:
an independent NHS board to allocate resources to different parts of the country and make access to the NHS more equal
Looks like central control to me. And is this board going to make decisions about where resources should go?
We are also told that:
We will unleash an information revolution in the NHS by making detailed data about the performance of trusts, hospitals, GPs, doctors and other staff available to the public online so everyone will know who is providing a good service and who is falling behind.
So what information is going to be collected, and published online? Where will the decisions be made about what to monitor, how to present that information and how it might influence budgets, planning and delivery?
At the same time we’re told that:
To make sure all providers have the right incentives to succeed, we will implement a ‘payment for results’ system throughout the NHS.
We will give everyone the power to choose any healthcare provider that meets NHS standards.
So how are these results identified and accounted for?
We will reform the way drug companies are paid for NHS medicines so that any cost-effectivetreatment can be made available through the NHS, with drug providers paid according tothe value of their new treatments.
So how do we know what is cost effective, and what isn’t?
I could go on, but essentially the simplistic headline of ”fewer targets” is fundamentally undermined by lots and lots of performance management. It’s disappointing, it says little of any substance. The draft manifesto is a full of criticisms of the current system, with bland statements of how it will be made better. What we want to know is how it’s going to be made better, in practice, with examples. What is the impact on care pathways, how is the available money going to be used and how is patient choice and local freedom to be implemented?
The main conclusions of the draft appear to be more centralisation, more interference in local decision making and a few populist comments.
All that said, at least it contains more than the alternatives…