The chairman of the Independent Regulator of NHS Foundation Trusts, Bill Moyes, has called for less government interference in the NHS and greater private sector involvement to help extend patient choice and "make failure real."
Speaking at the sixth annual health care conference, organised by healthcare analysts LCS International Consulting, Dr Moyes said that determining whether a trust was failing was "gloriously ill defined." At the moment trusts were either deemed to be financially viable or on "the cliff edge of insolvency." He suggested a similar arrangement to that used for utilities such as gas and electricity, which offers an interim "special administration" stage before trusts were declared insolvent.
He also urged the Department of Health to be more hands-off in its relationship with the NHS. "[The department] shouldn’t be the headquarters of a corporate body, it should be more like a major insurance company with billions of dollars to spend." Its responsibility should be limited to purchasing rather than managing the providers.
And he opposed the present arrangement by which the department itself sets the tariffs for payment by results. "While I accept government as provider of the money has to set the parameters, I don’t think it’s acceptable for government to set the structure of tariffs or set the prices."
Decentralisation of control had to be combined with an opening up of the system to private competition, he added. "If we are going to see patient focus being a key part of the system then we have to make sure the system delivers a choice of provider. Choice is the key. We need a level playing field for all providers, whether public, private, or voluntary."
He also wondered whether it was realistic to confine patient choice to elective care, as was currently the case. "Can choice be limited to the hospital?" There was an argument for extending this to treatment modalities and clinicians.
Earlier Sir Cyril Chantler, chairman of the King’s Fund, speaking personally at the conference, which was entitled Pluralism and Real Patience Choice, suggested more managed care organisations could be set up in inner city areas to help keep people with chronic conditions out of hospital.
Managed care organisations, such as the Kaiser scheme currently being trialed in the United Kingdom for patients with complex conditions, have shown that they could maintain people in the community while improving quality and reducing costs, he said.
The key to this was competition. Competition between managed care organisations seems to encourage innovation as well as cooperation between managers and clinicians and to give the organisations big incentives to maintain their clients’ health. "It’s difficult to think of any part of the NHS where incentives work in this way."
The new organisations, which could be run by primary care trusts, would need to be effectively regulated. But so long as they were sufficiently large—Sir Cyril said that they would need to treat a minimum of 20 000 clients—they offered the possibility of genuine accountability to their patients rather than health bodies.