Prepare for rationing?

Civitas, 16 July 2009

Earlier in the week, the Health Service Journal published the results of a survey of NHS finance directors, in which 32 out of 35 participants, from PCTs, mental health and acute trusts.  Two things are worth noting.

One, the most significant change in resource allocation they are planning this year is to renegotiate supplier contracts.   This is a costly process.  If it is used to drive performance where existing providers are not up-to-scratch as is the logic of competitive tendering, then fine – game on.  But if it is to simply renegotiate volume, one has to ask – given that many weren’t signed off too long ago – why they weren’t negotiated properly in the first place?  The ultimate threat of taking business elsewhere is a powerful one, but the tendency to focus on renegotiating contracts with existing suppliers seems to inhibit opportunities to garner the trust and mutual benefit developed through long-term partnerships with suppliers.  A hard enough task with the constant leadership turnover in the NHS.

But second, and more worryingly, only five of the 35 said they would be changing how they spend to improve patient care and quality.  The government’s erstwhile mantra that ‘quality’ is cheap, get things right first time and you save yourself many costs down the line doesn’t seem to be washing on the frontline.  Here, at least, the government are right.  The NHS needs to be seeing things as a function of value not just cost; if it doesn’t we’re going to be heading down a very uncomfortable path… or rationing and declining quality.