Magazine article Public Finance

Systems Man

Magazine article Public Finance

Systems Man

Article excerpt

IF YOU ASKED Professor Chris Ham what the top health priority should be in 2010. he wouldn't suggest handing commissioning powers over to GPs at the earliest opportunity.

But Health Secretary Andrew Lansley has set out ambitious plans to do just that in his July 12 white paper - which, in the process, will completely rearrange the internal market system that is the financial basis for the NHS.

Lansley's plan to give GP consortiums about £H()bn a year - four-fifths of the NHS budget - to purchase hospital treatments would kill off primary care trusts, which currently control that cash. The radical shake-up is being billed as the biggest in 60 years and would also lead to the scrapping of strategic health authorities.

However, Ham - who took over from Niall Dickson as chief executive of the King's Fund in April - identifies a different set of priorities.

And there can be few more qualified to speak than him. With more than 30 years' experience in health policy, he has advised the World Health Organisation and governments across the globe. Ham also used to run the Department of Health's strategy unit and, until recently. was a fellow at the Nuffield Trust. He retains a position at the University of Birmingham's Health Services Management Centre.

The organisation he now leads occupies a 'unique space within health care in this country', and has an international reputation, according to Andy McKeon. the Audit Commission's managing director for health.

The King's Fund supports health providers in implementing policy on the ground, and offers professional support to clinicians and health managers. The think-tank is also rare in that it has no political leanings. 'The chief executive of the King's Fund has always had an influential national voice,' adds McKeon.

Ham asserts his command of the subject lightly, and has a lively, affable presence. Although quietly spoken, he does not shy from expressing serious reservations about aspects of government health care policy - or of exposing its apparent contradictions.

Within a couple of minutes of sitting down, Hani targets Lansley's pledge to prevent the closure of hospitals and accident & emergency units, saying this is at odds with the imperative to improve care. 'Changes are necessary and desirable,' he argues. 'Lansley has been very clear that quality and outcomes are important... The contradiction is, can you pursue that policy at the same time as saying no to reconfigurations that aren't supported locally?'

And, rather than sweeping reforms to commissioning, he tells Public Finance: 'The first priority has to be the [Department of Health initiative] Quality, Innovation, Productivity and Prevention programme'. This, he says, is essential for the NHS to meet its target of £15bn-£20bn savings by 2014, which was set by the previous government.

'There are opportunities to become more productive, in procurement, clinical practice or back-office functions', but the challenge of putting Qipp into practice remains. 'This isn't sexy stuff.' Ham says, 'but there are questions over whether the capacity exists to make it happen.'

He suggests the focus on large-scale reform- which is exactly the sort of 'sexy stuff that could ensure a health secretary's place in history - could direct efforts away from generating savings through smarter working.

Early interventions to stop people becoming more expensively sick in the future is central to a cheaper yet more effective NHS, he says. Today's obesity, smoking and alcohol abuse threaten to create a long-term burden of ill health that would be 'unsupportable in a universal, tax-funded NHS'. …

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