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WHAT WILL THE NEW MARKET IN HEALTH CARE MEAN FOR THE PROFESSIONALS WE EDUCATE? Sally Ruane. Context: two political choices. Tackle the deficit primarily through public spending cuts Undertake complex top-down reorganisation in this context. Financial environment.
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WHAT WILL THE NEW MARKET IN HEALTH CARE MEAN FOR THE PROFESSIONALS WE EDUCATE? Sally Ruane
Context: two political choices • Tackle the deficit primarily through public spending cuts • Undertake complex top-down reorganisation in this context
Financial environment • Promise of real terms increase plus protected funding • 0.1% p.a. real terms rise • £15-20bn ‘efficiency savings’ (5% p.a.) • Reorganisation costing £2-3bn • Transfer of £1bn out of NHS to LAs for social care (not ring-fenced)
Implications • ‘Increase’ experienced as a cut • Cuts to services • Job insecurity • ‘Back office’, ‘front-line’, ‘management’
Financial aspects of GPCCa • GP Commissioning Consortia (GPCCa) must bear financial risk • But patient populations are small and funding formula may not work • General financial squeeze
Financial aspects of GPCCa (cont.) • High admin costs of health systems run as markets: • 6% budget (‘70s); 14% (2003); 15-20%?? 2010; • Proliferation of 500+ consortia – even higher admin costs?
Implications • Financial viability of some consortia at risk • Pressure of financial risk and constraints will ripple out to staff in primary care and in other sectors of health contracting with GPCCa • Mergers?
Quality • Financial squeeze • New market will re-introduce price competition • Economic theory and empirical evidence • Safeguarding quality nationally? • NICE Quality Standards not mandatory
Quality (cont.) • Licensing arrangements for providers – exante regulation • Care Quality Commission – weak? • Locally set quality standards but with financial constraints • Performance management of contract - inadequate
Implications • Pressure on staff to reduce costs to compete on price • Accommodating a decline in standards?
Commercialism • GPCCa – a misnomer? • Commissioning is a largely commercial activity • Involvement of ex PCT staff; out of hours provider companies; large insurance companies operating under FESC (Framework for the procurement of External Support for Commissioning, 2007)
Commercialism (cont.) • So commissioning will involve commercial actors and will be a culturally more commercial activity
Commercialism (cont.) • Provider side of market: • Tilt market towards more commercial and non NHS providers • Regulator will prioritise rules of competition • ISTCs; private hospitals in Extended Choice Network; take-over of NHS hospitals
Commercialism (cont.) • Commercial providers will: • Seek profitable activity • Jealously guard innovations and slow dissemination of good practice • Seek to reduce costs – staff numbers; staff skill mix; staff autonomy • Perform to contract (and no more) • Prioritise the interests of shareholders
Implications • skill-mix; • autonomy; • ability to share good practice and utilise professional networks to the best • Denial of treatment? • ‘Over-treatment’?
Market • Will the rules of competition become paramount? • Dynamic or instability? • Failure regime for NHS hospitals etc which cannot remain financially solvent • Hollowing out of NHS • FTs allowed to charge for health care
Implications of market • Job insecurity and prospect of transfer to non NHS employers • Triple tier workforce • How much professional energy and resources diverted to profitable activity with paying patients? • Organisational fragmentation will vitiate professional networks
Conclusion • Professionalism in UK health care has developed for over half century in a context of public service and divorced from the profit motive • Emergent commercialism will more significantly shape the professionalism of the future