Although it is not SHA policy many of us are drawn to the idea of a publicly owned, publicly provided and publicly accountable NHS (3Ps). We have tried many times to persuade those who are in favour of this to set out what it actually means, how we would be able to make the transition from the NHS of today (or 2015), and what the impact would be; how long it would take, what it would cost, what governance would be necessary and how funds would flow. We need to understand what the 3Ps NHS would be like, compare it with what we have now and work out the implications of the transition.
Our understanding is that this 3Ps model must mean all premises and facilities used for NHS services are owned by the NHS and all those who provide services to the NHS are employees. Private provision would be permitted but strictly separate and private providers of healthcare would be regulated and have to deposit a bond to reimburse the NHS for any NHS costs their “customers” incurred. Hospitals and GPs would be either private or NHS but not both. GPs would be NHS employees along with the practice staff.
There would be no commissioning; NHS services would be funded directly from the centre presumably based on current expenditure uplifted periodically for inflation. GPs would retain their gate keeping role but patients would be referred to a specific NHS setting. Planning, performance management (of the system) and quality assurance would be through a top down management structure, presumably with regional and local nodes, and all senior executives would be appointed. There would be no non-executive directors and no direct involvement of patients or public. Social care would remain separate.
The variation around this could include having local health boards – with elected/appointed members which would be funded by formula. This brings an element of commissioning back. Also providers (especially) hospitals could have a degree of autonomy with their own management boards with some elected and some appointed directors. Public health, community and primary care could also have separate governance structures and funding but again this brings back commission and the C/P split in some form. We could also find a role for some variation on Community Health Councils.
There are many possibilities and it would be helpful if one of the advocates of 3Ps could write a paper with some proposals and some information.