Shhh! Don’t mention the patients!

I’ve been reading Board papers again – a habit I really need to break.

Don’t struggle too much with the detail of this, but here’s a typical paragraph:

SLAs between PCTs – De-hosting and full cost recovery – the old District Health Authorities and community or whole district Trusts were disaggregated to PCTs five years ago. This was not a straightforward process, as information systems and costing methodologies were much less developed then than they are now. In many cases, pragmatic decisions were taken. The issue of shared services and provider SLAs which do not recover at full cost becomes increasingly important with the separation of PCT provider and commissioning functions, and with provider services increasingly needing to compete with other potential providers. SLAs which result in one PCT provider including in its cost base all the estates costs and overhead for some of its services distort the service line costs for both PCTs. PCT providers should therefore notify other PCTs by 30 November of the areas which they propose are reviewed for 2008/9 and PCTs should agree a process for detailing and agreeing the impact by 31 December. PCTs will need to demonstrate a fair distribution of overheads following the proposed re costing. No resource limit adjustments will be undertaken in respect of these changes as they will all have the effect of aligning spending more closely with the capitation based resource limit of the responsible commissioner. In order to accurately cost provider services, PCTs must be able to allocate an appropriate fair proportion of overheads to the provider arm of the PCT. In addition, it is clear that the current allocation of overheads varies across PCTs and a clear methodology is required that shows how support services have been allocated and demonstrate that an appropriate share of costs has been allocated to both provider and commissioner. Further detailed guidance will be developed with PCT FDs.

At a superficial level, you look at this and marvel at people who can construct syntactically perfect sentences that mean nothing at all.

The trouble is, there is a meaning here, as there is in most Board papers like this. This is all about separating ‘commissioner’ and ‘provider’ services to make it easier to hand over the provision of clinical services to the private sector. It’s also about running the NHS as a series of competing businesses. The language is increasingly that of big business. Another paper I looked at today talked about our ‘range of products’, and about ‘units of production’.

Patients? Healthcare? Quality of care? All of that is old hat. Gordon Brown’s NHS is about ‘market testing’, fragmentation, and out and out privatisation.


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