This is the first post (hopefully of many) by Rachel Calton.
Rapid reforms are underway within health service provision. The abolition of PCTs, the move to GP commissioning, and introduction of ‘any willing provider’ model to service provision have all given way to fears for the future of the NHS, primarily that the National Health Service will no longer be national, and that standards such as waiting times will be more difficult to set and to monitor. On the other hand the changes have the potential to open up opportunities for the third sector, in terms of taking on services, providing information and stepping in to monitor health provision for particular groups, with particular needs.
The Information Revolution White Paper for example – which details the Department of Health’s plans to harness digital technology to improve efficiency, including allowing patients to liaise with GPs via email and book in for appointments online – welcomes third sector organisations to bid for the role of information providers. However, what’s missing is the detail of the support on offer for third sector organisations to pitch against providers
with more experience at bidding for contracts, and the funds that will be available to facilitate reaching the audiences more at risk of exclusion from a mainstream revolution in how information is provided, and accessed.
The Choice and Control White Paper which accompanies An Information Revolution proposes that within the NHS patients chose their GP, unrestricted by postcode, and specify anything from their surgeon-led team, to the hospital they are seen in. Of course, choice traditionally benefits the most privileged before the most vulnerable, which is why, again, the third sector is an important broker in ensuring these reforms succeed in breaking down health inequalities, rather than reinforcing them.
In terms of opening up service provision, factors that are bound to inform the way that the proposed health reforms are realised, and the role of the third sector within these, are commissioning culture, behaviour and values. The skills and personalities of commissioners are pivotal to how public money is spent, the services that are provided, and the nature of the support that the most vulnerable people in society receive, and they are currently under close scrutiny. It is agreed that for change to happen, commissioners must be consultative, outcomes driven and co-productive.
However, although these terms are rife in government and think tank language and thinking, in many cases the culture shift has yet to occur. Sharp cuts in funding and sound case studies from funders could however combine to become an instigator of change.
At a seminar at NESCO on ‘Shaking Up Commissioning’, in advance of the green paper on public services this year, one delegate and commissioner of youth services recounted ripping up 140-page Connexions contract and replacing it with a single A4 sheet specifying a given outcome and timeframe, with which to invite services to tender, whilst another extolled the virtues of co-designing services with service users as both enabling and empowering. Whether trailblazers such as these becomes the norm or remain the exception could be key to whether reform really does make way for innovation and break from traditional service models or not.
