Magazine article Public Finance

A Patient Approach

Magazine article Public Finance

A Patient Approach

Article excerpt

VISITING CHELSEA & WESTMINSTER Hospital on a spring morning, it is easy to see why the light and airy modern building on London's Fulham Road has attracted much acclaim since its opening by the Queen in 1993. The design incorporates a vast central atrium and an array of visual arts, providing a pleasant and calm environment for patients, staff and visitors as they move around its six stories, fronted by huge revolving doors.

Its successes go well beyond the architectural, however. The acute, teaching and research hospital has gained a reputation for high-quality care and good management, achieving foundation trust status in 2006. Its finances are well run too, with regulator Monitor ranking the trust as 'lowest risk'. It is also a pioneer of 'patient-level costing', a method of linking spending directly to patients to show variations.

But unprecedented demands are about to descend on this secure edifice, as the health service in England undergoes a shake-up that could prove the biggest in its 60-year history. With the controversial Health & Social Care Bill, the coalition government is poised to pass responsibility for buying care to GPs, along with the lion's share of the health budget, and to open up the market to 'any willing provider' from 2013. At the same time, the NHS has to save a record £20bn by 2014/15.

Fortunately, Chelsea & Westminster finance director Lorraine Bewes is no novice when it comes to structural changes in the NHS. She has never shied away from politically contentious jobs. In fact, that was one of the things that attracted her to the health service in the first place.

Bewes began her NHS career in the early 1990s. Then the Conservative administration introduced an internal market, making some GPs fundholders who purchased care for their patients. Deemed radical at the time, the innovation was scrapped by the subsequent Labour government.

Bewes says she has seen 'a lot of tinkering with the whole structure and the philosophy of what works best'. But it doesn't appear· to worry her. Her experience of the first attempt to pass funds to GPs, albeit on a much smaller scale, makes her think things will turn out better this time around.

'I don't think the ambition was quite the same,' she says. 'We now have the benefit of looking at the impact of a market and it hasn't completely folded over. Philosophically, I come from the private sector originally. I believe it is healthy to have some contestability and I do believe in patient choice.'

Bewes' spell in the commercial sector, including with broadcaster ITN, came after qualifying as an accountant at Arthur Young and studying history and economics at Trinity College, Oxford. But since she moved into a regional health authority, she has never looked back.

Sitting on the health care provider side two decades on, Bewes is 'watching, waiting and anticipating* how the reforms will pan out, keeping as ahead of the game as possible. She doesn't underestimate the risks involved in handing GPs £60bn of the health budget and judges it 'unrealistic' that everything will be achieved by the end of this Parliament, as the coalition hopes.

Arguably the more daunting challenge now facing Bewes is in finding the hospital's share of the £lbn savings expected of the northwest London region over the next four years. Some £700m of savings have been identified so far.

Bewes is confident. She says: 'In this part of London it is acknowledged that there are too many hospitals and that is going to have to be resolved. Being a foundation trust is good because it means we are part of the solution and not part of the problem. …

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