Friday, 11 May 2012

Interview : Prof Ian Shaw (short version)

An extra-short version of recent interview wwith Prof Ian Shaw for the time poor / attention span challenged out there (long version here). Prof Ian Shaw is the Professor of Health Policy at the University of Nottingham’s School of Sociology and Social Policy, and is also (amongst other things) a Non-Executive Director of NHS Nottingham City Primary Care Trust.

BFTF: How can people find out more about what the directors of the NHS are doing?

Ian Shaw : The best thing to do at the moment, because we are in a period of transition, moving from PCTs being in charge of the buying and selling of health services. . .to the clinical commissioning groups doing it. If you google “NHS Nottingham City” you’ll get the website with both the CCG and the PCT and all the board papers are on there, published at least a week in advance and the public is welcome to ask questions which are read out in board and to attend the board meetings as well.

BFTF: You have a very interesting blog and one of the posts was about the “Kidderminster Effect” and how competition doesn’t always pan out to be a good thing. Can you give a little more information on this?

Ian Shaw : Kidderminster was a district general hospital, a bit like the QMC only a lot smaller, in Worcestershire. And Worcestershire had [but didn't really need] three district general hospitals serving around 526,000 people. . .so they decided to beef up two and close Kidderminster.And they did it BADLY. They didn’t tell people WHY they needed to close Kidderminster. . . it wasn’t explained to the doctors in the communities, they just decided to do it. And it was a misunderstanding about who owns the NHS. The managers thought they owned it. They don’t - the people own it.

BFTF: Moving on a little to talk about competition. On the one hand superficially you can understand it, people are competing, they’ll try harder. But then you think about within an organisation - suppose you have an engineering company with five engineers - if they are all each keeping their good practice to themselves, they are hoarding their secrets, they don’t want to co-operate with the other engineers - that company isn’t going to last very long. How do those two drivers relate to the NHS?

Ian Shaw : There is what’s happened historically and there is what is going to happen in the future - so I’ll handle those separately.

What has happened in the past is that going back to 1997 . . . at that time there were people waiting for nine months on waiting lists - and that wasn’t uncommon so what the NHS did was say, here are some more resources, we want more facilities but also, if you can use the private sector sensibly where there are large queues to take the pressure until this new money in the NHS can build capacity then that is a sensible way to do it.

A&E Department, QMC, Nottingham

So that was the situation before the introduction of the NHS and Community Care Bill. The situation after its introduction, which is now, is that all significant contracts are going to have to be put on open tender. That means that the private sector can compete with your local community NHS service for example or your out-of-hours doctors service to compete for that service. They will compete on costs and on quality and it is up to the primary care trust at the moment, CCG’s soon, to procure those services through a contracting procedure and monitor them once the contract has been done.

BFTF: How does European competition law and the wish to balance cost and quality affect how decisions might be made?

Ian Shaw : If - IF - the contract continues to be based on quality so that it is the same quality going across and what you are doing is competing on quality then that is not necessarily a bad thing. . . It’s get into difficult waters if you start competing price, if you compete on price you are goinf to be driving the quality levels down. Competition has got to be done on quality and at the moment the safeguard is still there for competition to be done on quality but it’s literally a very small safeguard. . .

BFTF: You have mentioned a House of Commons report that stated that transaction costs were 14% of NHS total costs, but that there was no evidence that these transactions delivered 14% more productivity. Could you just elaborate on that a little bit?

Ian Shaw : This was the House of Commons select committee report in 2009, which showed 14% of the total budget going transaction costs - they buying and selling of goods and services in the market, the contracting and the monitoring of these contracts . . .and there was no evidence at all that this was creating 14% of added value in terms of productivity or quality. . . . A big worry for me is that the level of management costs in these new commissioning groups is capped so it is going to be challenging to do all of the monitoring of the contracts, the quality assurance that they are going to have to do with increased numbers of providers.

BFTF: Can ordinary citizens challenge their local Conservative or Lib Dem parties or the Dept of Health and say “Can you assure me, as a Citizen, that these contacts are going to be monitored adequately?”

Ian Shaw : . . The big thing is the Health and Wellbeing boards which are set up by local authority area and decide the health and social care strategy for the communities which they serve. The elected representatives, councillors, form a large group on that board so that the attitudes of the councillors are REALLY important for how this is going to role out within a locality.

Harltey Road Medical Centre, Nottingham
BFTF: Why am I hearing these clearly defined points from you? Why didn’t I hear it on the news? Why didn’t I hear it from the MPs?

Ian Shaw : That is a long argument. Twitter has been alive with criticism over the BBC particularly on their reporting of the NHS reforms and particularly the protests against the NHS reforms. There is not one single Royal College or Union which has not stood up to these reforms. They are trying to impose reforms on the NHS when all the Royal Colleges and unions are against it. . . Al Jazeera covered the NHS protests far better than the BBC. . .

BFTF: One other point about the Bill, perhaps a bit of a technical point, but one that is often mentioned is that the Bill allows Trusts to take up to 49% of private work [compared to a 3% cap before]. What is the concern here?

Ian Shaw : The concern is two fold. Firstly, most of the big NHS Trusts are working at full capacity anyway, so where are they going to get 49% of free space to bring in private patients. . . And the second thing is, why on earth would someone want to go privately when they can have things done free, to a good quality, in a timely manner within the NHS where they also have choice.

BFTF: Before we wind up the interview, is there any key message you want to get across to the public.?

Ian Shaw : There is concern about the direction of travel of the NHS. . . I am concerned that the “free at the point of use” bit - which is there now, it’s there with these new reforms but I think it might be under threat in the future. Bevan said that the NHS would be there so long as people defend it and I think that people need to be aware that it needs defending.

BFTF: Do you think it might go the way of dentistry has gone?

Ian Shaw : Well that is one of the scenarios on under this direction of travel. You might get the basic service free but they might say, “well, you’re in a bed, we’re changing your sheets, we are going to charge you hotel fees and we’re feeding you so we are going to charge you for food”. You can see the ways in which a cash starved service might keep to the letter of free-at-the-point-of-use but actually the add-ons become very expensive and in the US almost half of all bankruptcies are because they cannot afford to pay their medical bills and I would hate to see Britain move to that situation - nobody is suggesting that they are moving to that situation at the moment but I think that really we need to be alert to the possibilities that the direction of travel is moving.
NHS Flag, QMC, Nottingham

Notes:

You may also be interested in this post : "This is what is what is wrong with the NHS Bill"

Prof Shaw was interviewed on the Buidling for the Future show (Wednesdays at 5.15pm ish) on Radio Dawn 107.6FM, one of Nottinghams community radio stations.

Image Sources: All BFTF's own.

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