From the silly season’s decline and fall, we are warming up to the party conference season. On Tuesday, The Indpenedent’s Andrew Grice revealed that Gordon Brown has now accepted that public spending will have to be cut: an announcement of some kind of review should probably be expected for the leader’s speech.

Recessionomics have changed the political lingua franca. Today, The Independent also featured a bit of a non-story about a Tory MEP suggesting a £10 charge for GP visits and missed outpatient appointments.

It is a relief to see that shadow health secretary Andrew Lansley has got his sensible head back on to diss this silly suggestion. As we pointed out following the unfortunately disappointing recent report from the SMF suggesting a £20 charge per GP visit (capped at £100 a year), the revenue raised would very probably be negative, and the damage to both preventative and public health and the image of GPs potnetialy serious.

Lib Dems forward thinking
The more interesting policy suggestion to emerge today comes from Lib Dem leader Nick Clegg, who The Guardian suggests will state that all hospital operations (more or less) should be paid for at the cost achieved by the most efficient providers.

Interestingly, the promised interview has not yet appeared. However, the website for saving suggestions from public sector workers - www.nickclegg.com/intheknow – is up and running.

Clegg acknowledges that his policy cannot be implemented across-the-board overnight: "There has to be suppleness in it … we are not going to be stupid about it." His insight in the asymmetries of power between provider hospital trusts and commissioners, however, seems difficult to refute.

The more so given the Audit Commission’s recent revelations about ongoing inaccuracies in coding of hospital data.

The Commission’s second annual PbR Data Assurance Framework shows that in the cases audited last year, over 12 per cent of the clinical codes for diagnoses and procedures were wrong (an improvement on 2007/08’s figure of 16.5 per cent - with particularly notable improvement in specialist trusts, such as hospitals for children, neurological, orthopaedic and cancer patients).

The report says errors continue to affect the accuracy of payments for treatments in the NHS. On average 8 per cent of payments in the cases audited were wrong in 2008/09, down from 9.4 per cent in 2007/08. However, they discount attempts to financially game through the errors.

We want information. Information. Information.
This is also a matter of the information asymmetry between commissioners and providers. The point about data quality – and medical record quality, as highlighted in yesterday’s Patients Association report – is that both are essential not only for good-quality care but for cost-effectiveness to be understood and used by clinical staff; not merely managers.

For data to drive changes in clinical practice that will lead to better and more cost-effective healthcare, data must be made not only more accurate but more obviously useful.

The axiomatic devil in the rhetorical hangout
There are always risks to change. However, Norman Lamb has been coming up with good ideas since being appointed their health spokesman. His conference speech may be as interesting as last year’s.

Much more detail on the how of such a policy is needed. But credit is due to the Lib Dems for putting the proposal up for debate. Whether we will in time move towards a Dutch auction system for care is unlikely; however, the principle of exploring how more value can be delivered for the healthcare yen seems unarguable.

The fundamental premise, however, of moving away from an average towards the best performers, is already accepted in the Operating Framework. How fast providers can safely move will be a matter of question. How much confidence the change attracts from the clinical community will determine its chances of success.

Shrouds can get dusted off for waving very quickly.