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Editor's blog Wednesday 22 July 2009: It's the end of the world as we know it. Again. | Health Policy Insight
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Editor's blog Wednesday 22 July 2009: It's the end of the world as we know it. Again.

Publish Date/Time: 
07/22/2009 - 05:53

Good morning. It's dark and raining here in Burgundy, schadenfreude-holiday types. Still, mustn't grumble: it's not in the commissioning plan.

Interesting news on the front page of FT.com this morning. Nick Timmins reports that the private sector has been asked to take over the management of Hitchingbrooke DGH on a franchise basis, with private operators and NHS foundation trusts "being invited to take on its running and financial risk".

What is curious is that this appears to be little different from the franchising of the management, a periodically-reannounced policy placebo of the DH's. It has been tried only once, unsuccessfully, when Tribal took over the management of Good Hope in Birmingham (although its deficits were reduced and its 'star' rating improved).

Hitchingbrooke will not be allowed to shut its A&E or maternity services. Its staff remain in the NHS, and the asset still belongs to the NHS. Nick suggests that the scale of the financial risk to be assumed (Hitchingbrooke has a near-£40 million deficit on a £90 million turnover) is the significant difference.

It seems very unlikely that Monitor would want to authorise an FT to take on this level of financial risk. As Nick's interviewees from private sector operators point out, the terms proposed leave a likely private sector operator constrained in their potential room for manoeuvre.

Crucially, it is unclear whether the PCTs of the region will be required to commission guaranteed levels of activity from Hitchingbrooke. With this guarantee would come two things: a repeat of the 'take or pay' fiasco over independent-sector treatment centres; and a confirmation that commissioning is out the window. Without this guarantee, what looks like a virility symbol for the pro-market camp could simply be the first stage in managing public expectations over an eventual downgrading or closure.

Elsewhere, The Guardian reports on the latest developments in US healthcare reform.

Meanwhile, its business pages report that General Healthcare's profitable nature may be starting some consolidation in the precarious private sector provision marketplace. Its putative prey, Covenant, was over-extended in private equity-related leverage of over £100 million from Bank of Scotland (now owned by Lloyds (and of course the taxpayer).

General Healthcare is, the article notes, "majority-owned by Netcare South Africa, with a 35% stake held by private equity firm Apax" - co-owners (with Guardian Media Group) of highly-leveraged Emap, publishers of Health Service Journal.

The Guardian also has this thoughtful reflection on Lord Darzi's time on office on the day of his departure, by the estimable Michael White.

But goodness! Could Lord Darzi be stepping out of the political frying pan into the academic fire? Imperial seem to be in trouble ...

And The Times reports a proposal for greater public scrutiny of NHS chief executives by ex-heath minister and now communities secretary John Denham. Town hall public meetings would, like Parliament's select committees, be abe to summon civil servants and to hear from the public.

However, crucially, the committees would have no enforcement powers beyond their ability to 'name and shame'.