In a curious piece of news management, last week the Government managed to announce £800 million of funding for medical research – surely a good news story – on the same day as A-level results, Syria, riot aftermath and seemingly ongoing market meltdown. For journalists, there were many more compelling stories than investment in things they don’t understand. For the picture desk, delighted boffins were never really going to compete with ecstatic female A-level students. Thursday was indeed a good day to bury good news.
Yet there was another health story which was overshadowed last week – the impressive drop in the number of patients being cared for on mixed sex wards – which played second fiddle to renewed rows about waiting times. In a week when information on 18 weeks and cancer waits was released, it was pretty easy to claim any pattern you wanted. Predictably interpretations ranged from “waiting times stable” to “waiting times soar.” Depending on your interpretation of “stability” and “soaring,” both probably had some justification.
So what has changed? The Government’s latest approach has essentially had two strands: transparency and incentives. Data on single sex accommodation breaches has been published by provider and a new system of daily fines have been introduced. My understanding is that it took an unholy battle to get the data published in the first place, with all the usual excuses about inaccuracies and giving the NHS time to prepare being rolled out. Yet the combination of measures appears to have worked. This is a good proof of concept for some of the NHS reforms (transparency and incentives are, after all, critical – and less controversial – strands of the Government’s vision).
The test, then, becomes can this approach be applied to other issues? Take waiting times, which have long been the domain of national targets. The Government may have downplayed waiting time targets, but the measurement and contractual and constitutional commitments remained in place. The NHS Standard Acute Services Contract actually now includes penalties for elective waiting time breaches and there is certainly plenty of transparency (and scrutiny) around waiting times performance, so the same approach as to mixed sex accommodation should be possible.
The issue may be that it is commissioners and not providers who are the problem. The Cooperation and Competition Panel’s recent report indicated that some commissioners are quite happy to go slow even when there is provider capacity available, thereby slowing down expenditure. This is not the case for mixed sex accommodation where the problem lay on the provider side and there are no financial implications for commissioners from improving performance. If this is the case, then transparency and incentives may be more powerful levels for providers than they are commissioners.
Of course there are many who argue that the NHS’ recent performance on waiting times remains strong in very testing conditions. Yet there is growing pessimism in the health service that this will be maintained. The warning signs of longer waits could easily become something rather more politically dangerous. Given the continuing profile (and public resonance) of waiting times as an issue, the Department of Health will be acutely sensitive to this. It needs to find a way to ensure that short term commissioner interests do not neutralise the potential impact of financial incentives and public transparency.