Kevin Lewis column

Kevin Lewis reflects on the recent ministerial changes at the Department of Health.


Keen and eager


So now we have it. Patricia Hewitt has taken her last pasting at the hands of the nursing profession, although I must say that in her early media appearances during the silly season, Dawn Primarolo (the new Minister of State for Public Health) has been doing a cracking impression of the former Secretary of State for Health. Listen to her with your eyes shut (please note that this is not necessary if she is on the radio), and you will see what I mean. The new Department of Health team under Alan Johnson brings together several individuals who have done pretty well in other jobs so it will be interesting to see how they fare in whatever time is available before the next general election.

Responsibility for dentistry (aka ‘The Poisoned Chalice’) has passed from Rosie Winterton to Ann Keen. She has a very credible healthcare pedigree (in the nursing profession) and another part of her quite wide portfolio as Parliamentary Under-Secretary of State for Health is that of hospital hygiene (aka ‘The Infected Chalice’). Ann Keen was formerly at the Treasury, working as Gordon Brown’s parliamentary private secretary, so one can only assume that she must have done something to annoy him.

Rosie Winterton had been in post long enough for people to know where she stood on a number of key issues; she was there before, during and since the new dental contract. Ann Keen is coming into the role in an altogether different context, and no doubt there will be those who will see this as an opportunity to re-visit some of the problem areas.

One such group is Challenge, which held its ‘summit’ meeting to coincide with the LDC Conference in Birmingham back in June. I wasn’t able to attend but I have heard (and seen from the ensuing report) that those ‘movers and shakers’ who attended were broadly agreed that some of the most fundamental tenets of the new contract needed to be reconsidered as a matter of urgency. The new Minister must be reeling with the spectrum of views as to how the new contract is working, what needs to be ‘fixed’, and when and how this should be done. The BDA, the DPA and Challenge are not entirely united in their views on these issues. PCTs certainly aren’t, and the differences in approach – even in adjoining PCTs within the same SHA area – are becoming more striking as time passes, not less so. The Department, one gathers, is increasingly of the view that everything is bedding down very nicely and is not sure what all the fuss is about.

Any change of ministerial responsibility brings a change of personalities, a shift in the dynamic of relationships and the possibility of a shift in position that creates less political fallout than a change of direction by an incumbent Minister. John Reid’s famous ‘not fit for purpose’ offering when he arrived at the Home Office is a case in point. His comments were interesting – even if fuelled by a hint of self protection – because he was still saying the same thing after a year in post. It is both unusual and refreshing when a Minister does not endlessly pretend that a goose is a swan, when everyone can see that it’s a goose.

Under normal circumstances, a new Minister enjoys a brief honeymoon period in which everyone knows that the civil servants are briefing heavily and drafting Ministerial statements so that our political masters do not inadvertently become the latest reality TV show. Picture if you will:
‘What the hell is a UDA, Sir Barry? Isn’t it something to do with Northern Ireland?’
‘No, Minister. There aren’t any UDAs in Northern Ireland – at least, not yet. Nor in Scotland I gather. But there are millions of UDAs in England and Wales.’
‘Is that good news or bad news? Do we like UDAs, Sir Barry?’
‘Oh yes, we love them, Minister. In fact, we can’t get enough of them. Unfortunately, that’s the problem. We aren’t getting enough of them.’

Nip and tuck
Talking about UDA shortfalls, word is filtering out about the long-awaited ‘clawbacks’. As predicted, the same level of shortfall is being treated in widely varying ways from one PCT to another and even, it seems, within the same PCT. The power bestowed upon the PCTs by the Health and Social Care (Community Health and Standards) Act 2003 is nowhere more in evidence than in the freedom the PCT has to ‘cut a deal’ with one provider, on a mutually agreed basis, while taking a much harder line with another provider who, while having exactly the same UDA shortfall, is not ‘delivering’ for the PCT in other ways that are placing the first provider in a more favourable light.

Particularly interesting, I think, is the approach being taken to the 4% ‘wiggle room’ around the target of achieving 95% of the UDAs which are (allegedly) equivalent to the ‘test year’ gross income and activity. In some PCTs the rule is being applied to the letter, and anyone delivering 90.8% of the UDA target is being asked to return the monetary equivalent of the whole of the ‘missing’ 4.1% of the UDAs, while another provider is being given additional time in which to make up the UDA shortfall, even when more than the 4% ‘funnel’ factored into the contract. Some providers are agreeing ‘deals’ where part or all of the UDA shortfall is being written off, sometimes on terms and conditions which suit the PCT’s ‘big picture’ of local service delivery.

The corollary of the clawbacks is, of course, that this frees up money which the PCT can then use to commission additional services from other providers. That’s if they don’t have other plans for the money, of course. And despite all the talk of ‘ring fencing’, there are more than a few CEOs and finance directors who do.

Short and sweet
And finally, Bart and Homer rule OK, it seems. Word has it that The Department of Health is no longer to be referred to by the acronym DoH, because this makes it far too easy for those with mischievous intent, to draw parallels with the much quoted Simpsonian soundbite ‘Doh!’, which is used to denote that the brain’s inbox is full. Instead we are to use the much more eco-friendly DH, which being one third shorter, will save paper, unclog jammed inboxes and free up vast acres of time right across the healthcare sector. This is time and money that can be put to good use, and no doubt we will soon see wards re-opening and both Relenza and Viagra freely available on the NHS. But hopefully not at the same time – although when you go down with flu, it’s important to keep your pecker up. Something for the new ministerial team to ponder, perhaps?

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