Information Director, London Health Emergency NHS chief executive Sir Nigel Crisp, once the darling of New Labour ministers for his willingness to parrot their latest market style "reforms", now appears to be living on borrowed time as the NHS plunges into massive deficits, and ambitious promises of ever improved performance on waiting times appear a distant pipe dream.
The chaos has been worsened by Crisp's own team at the Department of Health, who have made a dog's breakfast of the implementation of a controversial new svstem of "payment by results" which is due to be introduced from April this year.
The scheme, which is central to New Labour's drive to creating a new market in
care provision, designed to ensure that all hospitals are paid only a fixed cost for each item of treatment they deliver, and that they are paid per case rather than on the basis of block contracts.
However at the end of February, with just weeks to go until the roll-out of the system, the Department has been forced to recall its tariff of costs, amid evidence that they would destabilise acci250,000 staff working for Primary Care Trusts throughout England are still profoundly worried and unsure who will be their employers in the medium and longer term. dent and emergency units and force Trusts and Primary Care Trusts into crisis.
As a result of the recall, weeks of financial projections by up would-be Foundation Trust applicants have been rendered useless: but more to the point no NHS Irust or Primarv Care Irust knows how much they can expect to charge or will have to pay for any item of treatNICOL.
This is not the only element of uncertainty for which Crisp must be held accountabie. rollowing nis controver sial but exceeding v vague July 28 circular calling for a major upheaval in Primary Care Trusts and the separation between their role in commissioning services and their direct provision of services, 250,000 staff working for Primary Care Trusts throughout England are still profoundly worried and unsure who will be their employers in the medium and longer term. No clarification
While ministers have been obliged to step in and insist that there is no immediate requirement PCTs to divest themselves of the services they provide, Crisp has offered no clarification of who precisely he would propose should take responsibility for delivering the range of community, primary care and mental health services that alc currently provided by PCTs.
The original circular was widely perceived yet another lurch towards the privatisation of the NHS, and a foreshadowing of the White Paper on shifting health care out of hospitals published by Patricia Hewitt a month ago.
The White paper goes even further, with constant references to the growing role of the private sector, and an astonishing proposal to create a proceaure which would allow individuals or groups of service users who are dissatisfied with the quality of a local service to orce inelr local PCT to put the service out to tender, inviting private sector bids.
Significantly there is no corresponding mechanism to allow people aggrieved by the poor quality of a privatised service to petition to bring it back in-house.
This one-way and unequal process amounts to a consistent New Labour drive towards privatisation, epitomised by Tony Blair's recent meeting welcome the bosses of a dozen private sector providers into the
family", promising that the private sector could soon be delivering as much as 40 percent of NHS elective surgery.
The automalic, baseless and ideological conviction that private sector provision is necessarily of superior quality is matched with New Labour's unswerving conviction that if given a choice of hospital, most patients would "choose" a private hospital.
Experience however shows
UNIS KE that the opposite is the case.
Contracts already established with private sector Treatment Centres for a range of elective operations have been running well below the target levels as patients choose to go to proper NHS hospitals instead: increas ingly pressure is having to be used to force patients to use the new Treatment Centres or go withoul.
I he contracts for a second round of Treatment Centres are now out for tender -although the NHS is not allowed to bid for any of these lucrative contracts, meaning that the competition is purely between various private sector companies decide who carves up the juiciest and most profitable contracts. Seconded staff
The second wave contracts will be announced in the summer, but it is already clear that the new centres will take caseload transferred from the NHS, and as a result the •..TONY BLAIR LEADER OF THE OPPOSITION 71996 Department of Health allowing them to take NHS staff on secondment.
But even more significant is the fact that every thousand pounds spent in these new centres will be taken out of The l budgets providers, acepening the financial CLISIS that many already face and forcing the pace towards more cuts and Cosures
It is hard to believe that this aspect of the situation is an accident: the government has made plain its long term ambition to create sustain. able contestability" and a viable private sector to compete with the NHS.
From that point of view the more NHS services are forced out of business, the greater the scope for new private providers to step in and make profits.
So there may be a degree of method on Crisp's apparent chaos: but with growing evidence that the mainstream media are homing in on the NHS crisis to undermine the