Neuro Knees Up or Knockback?
Posted: 24 June, 2010 by Andrew Craig
News of Pathway Commissioning 
Packs and Tariffs
We are always looking to see how patient engagement and participation are reflected in official policies and local practices. But these issues took a back seat on our latest trawl through the revision to the 2010-11 Operating Framework (ROF) for the NHS in England published this week . What caught our eye was the unexpected statement (pp 11-12) that Government would make available a number of pathway/year of care tariff packages including for long term conditions.
To support the development of pathway tariffs, a number of ‘commissioning packs’ are in production, starting with cardiac rehabilitation, which is to be published shortly. Other commissioning packs will be published later this year and could include dementia, diabetes, chronic obstructive pulmonary disease, end of life care and stroke rehabilitation.
Must be Right Pathways and Right Tariffs
Is this good news or bad news? A knockback or a time for a celebratory knees up? Make no mistake, we like the idea of pathway tariffs based on year of care (YOC) approaches to long term conditions very much. We also like the idea of helping commissioners get it right where neurological conditions are concerned. But they have to be the right pathways and the right tariffs. MAC has worked closely with neurological organisations to create them for motor neurone disease and more recently for Parkinson’s disease.
Grab the Moment
This announcement in the ROF needs to be recognised and responded to quickly. This announcement, in effect, creates a public affairs opportunity for organisations working in the long term neurological conditions (LTNC) field to respond positively, thereby ensuring that ongoing work on year of care pathways and commissioning tools is recognised and valued by the new coalition government. It’s an opportunity with a short shelf life we think, so carpe diem.
Outcomes are the New Targets
Coalition health policy is clear: targets are on the way out and outcomes are coming in as the new focus. There is nothing essentially wrong with that, so long as they are the right outcomes and that there are consensus standards to refer to in order to keep the new commissioners and their providers on the straight and narrow where good neurological practice is concerned. Third Sector neuro organistions are excellently placed to make sure that the Government understands the work already going forward on MND, PD and MS YOC commissioning pathways in particular and that the outputs of this work are incorporated into the new government’s thinking about pathway tariffs and quality of outcomes.
Costings too low?
Our concern is that bodies sponsoring this work could suddenly find that centrally taken decisions about what is “affordable” will downplay quality and focus only on costs, and those costs will be lower – possibly very much lower – than the real costs being revealed by YOC work in long term neurological conditions. Centrally fashioned “commissioning packs” may have no user-led content in them and may not reflect the breadth and depth of health and social care inputs which appropriate year of care pathways must have.
Double Whammy -Diagnosis Delayed? Pathway Poor?
As the pre-diagnosis 18 week pathways targets are also being removed by the ROF, people with possible LTNC could face a double whammy: not getting a timely diagnosis and commencement of treatment and also not getting an appropriate care pathway in place which delivers quality outcomes that are affordable, deliverable and acceptable.
Which way now?
Things could go forwards or they could start to go backwards following the announcement in the ROF. One thing is clear to us: everyone concerned with long term neurological conditions needs to make sure that their voice is heard – loudly and often – and their investments in quality and effectiveness are not wasted.
Removal of performance management by the ROF for achievement of targets raises the clear danger of slipping/drifting back into long waiting lists and unresponsiveness, despite the Government’s stated intention that this should not happen and that PCT commissioners – assuming they haven’t succumbed to despondency – must hold providers to account for good outcomes. Many haven’t been very good at this in the past, so why should they suddenly get better?
The NHS is not focused on user satisfaction. Until it is, no wonder some people say they are worried about relaxing targets. A survey of 3,000 members of the public by research agency OnePoll (PR Week 25 June 2010 http://www.prweek.com/uk/news/1011885/Reputation-survey-National-Health-Service—Public-pans-A-E-plan/) should cause Mr Lansley to consider possible risks to his and the NHS’s reputation. Answering the question “which is your biggest concern about the NHS?”, the pollsters claim that 73% of respondents said scrapping the 4hr AA&E waiting target (now down to 95% achievement from 98% but with no performance management) was only a money saving measure unrelated to improvement in patient care. 64% wanted the target retained.
Of course, polls may tell us nothing, or at least nothing worth knowing. But public anxiety about relaxing standards can percolate to the surface very quickly. If it does about changes to NHS services, Ministers may find it hard to deal with. Perhaps that is why they are keen to establish the mooted independent NHS Commissioning Board, in order NOT to have to know and be expected to respond whenever someone drops a clanging bed pan on the ward (with apologies to Nye Bevan).