Sir Malcolm Grant at Expo

NHS Commissioning

On Tuesday I chanced to listen to Prof. Malcolm Grant from NHS England.  I had ventured to Olympia to hear Jeremy Hunt at Health Efficiency Technology Expo only to learn he had bunked off, perhaps to consult his lawyers.  His replacement Dr Poulter was reported as on the way, nearly there and then lost and he was replaced by someone telling us about some new Government Procurement miracle.  So Prof. Grant took the after lunch slot and even padded it out until there were no more questions.

Sir Malcolm Grant

The audience only contained one person in a slogan bearing T shirt so I feared the worst.  It sounded a bit like a discourse on an NHS insulated from the aggravation of the public and patients and devoid of any unhelpful political interest.  But actually a lot make sense.

The lecture began with the usual doom laden scenario about the demand for services outstripping our willingness to pay for them as we enter another period of less than level real terms funding and so we have to do “something”. Something pretty big.   But this was ok as the Lansley reforms could work if there was enough leadership and innovation.  Despite the acknowledged 20 year history of failure the latest attempt at commissioning within a kind of market was going to work.  Indeed it was already working as the Clinical Commissioning Groups were making improvements in GP world – I thought NHS England and not CCGs looked after GPs.

We had a good bit about the role of NHS England as a facilitator, not ever setting targets or being top down.  I thought of Stalinist facilitation where decision makers are supported and helped to reach the decisions they had been told to make.  We got a bit about the Mandate thing as well and another shout out for leadership.  I was puzzled by the reference to University College London Hospital as the model for leadership and stability as I was told a short while ago it was the model (only example) for successful turnaround through imposition of disruptive transformative new management.

A good bit was about how technology stuff like the huge computing power in our pockets, could transform care.  Given the context this had to imply us using it as consumers, making the market more efficient by closing the asymmetry of information that distorts markets in healthcare.  Or perhaps it just meant CCGs as the purchasers on our behalf could up their game.  There was an interesting point about how the system lacks the skills that will be needed to help us interpret the vast amount of information that will increasingly be routinely available – like our personal Genome.

The analysis was good but in the SHA we have been speaking of this in terms of how access to information and lots of ways to interpret and analyse it could transform “voice”.  We are more interested in direct involvement, shared decision making and community development than we are in perfect markets.

Perhaps the most contentious part was the view that major changes were necessary in the training of Doctors with much shorter timescales and a lot of continuing personal development.  That was good and fits with our ideas about training for different roles in a different world but it won’t be popular.

Sadly he ducked the question about who will replace Sir David.  I think this is because he will follow in the tradition of great governance set by his arch enemies in Monitor – he will be both Chair and Chief Executive.