Calum
Agreed!
Why is Times providing marketing space for Britnell and KPMG?
Have written Time a letter but am confident they will not print my 
objections to their marketing of NHS wares whjich may induce expenditure 
inflation and inefficiency in foreign parts
Go to it fella! Evidence needed to complement the modesty me thinks
Best Alan

Calum Paton wrote:
> Whatever happened to the British traits of 'stiff upper lip' and dignified
> understatement? It used to be a (no doubt inaccurate) piece of received
> wisdom that Americans overdosed on optimism whereas the Brits were
> hard-wired with restraint. No longer, were it ever true....or maybe it is
> England(I speak as a Scotsman) which has yielded to hyperbole, with
> 'metaphysical doubt' only remaining on the Celtic fringes!
>
> I opened my copy of The (London) Times this morning, to find an article
> entitled, 'How the NHS could make money for Britain', sub-titled 'We have
> a world-class service that we could sell to China, the Middle East and
> Africa.' It was written by Mark Britnell, who is now 'chairman of global
> health practice' at a well-known major consultancy but who was until a
> couple of years ago Director General for 'Commissioning' at the (London)
> Department of Health. He was a career NHS manager before that, becoming (a
> successful) CEO of a major Birmingham hospital trust and then CE of one of
> England's 'Strategic Health Authorities.'
>
> Mark seems to be fond of the moniker, 'world-class.' He is credited with
> devising the phrase 'World Class Commissioning' (WCC)in the mid-2000s,
> while at the Department of Health - which solidified into a major
> initiative, indeed industry, in the English NHS. All Primary Care Trusts
> (PCTs) - the NHS's 'commissioners' (ie bodies responsible for assessing
> their populations' need for medical and health care, and procuring
> services in the 'market to meet that need) - were regularly assessed
> through a complex, multi-dimensional 'tick-box' or check list, covering
> what were supposed to be all the elements of successful commissioning.
> 'Commissioning' is in effect strategic planning of services, but conducted
> in a market environment rather than a publicly-planned system. It was
> sometimes observed at the time that WCC became all about process, and this
> may be fair, in that a central aim was to ensure that PCT 'commissioners'
> were subjected to the sort of benchmarking which acute hospital and mental
> health Trusts had to undergo in order to become 'Foundation Trusts' (the
> initial linchpin of New Labour's 'new market' in the English NHS.)
>
> The Coalition government which came to power in 2010 has 'abolished'
> 'world-class commissioning' as a system, if not as an aspiration, in that
> the PCTs are to be abolished, with 'commissioning' in the future to be
> done by GP-dominated clinical groups. This assumes that the Health Bill
> 2011 is passed in the House of Lords - but elements of the reforms
> contained in the Bill are already happening 'de facto' on the ground. This
> continues the trend begun with the Thatcher reforms (what became the Act
> of 1990) of being impatient with old-fashioned inconveniences such as the
> legislative process.
>
> Cynics have of course pointed out that the major consultancy groups scent
> a major opportunity, at a time when a steely eye is being cast over (some
> of) their contracts with the public services and government, for work in
> and around the English NHS. With institutional memory departing the
> English NHS in a rush for the exits of many senior managers, the new
> 'commissioners' will need help, and lots of it. Mark Britnell's own work
> is global - there is no suggestion that he has moved from the public
> sector to the private through a revolving-door inappropriately. The point
> of this 'blog' is not, in other words, to 'pick on' Mark, who had a good
> NHS record by accounts, but to take his approach as an example of how
> consultants might be interpreted as viewing what is, in essence,
> comparative health care.
>
> What are the opportunities scented? One is that, in countries which need
> new hospitals, "we can use our extensive experience of public-private
> projects...." (he mentions China, Asia more widely, Africa and the Middle
> East.) The Private Finance Initiative (PFI) was the centrepiece of
> 'public-private projects' in the NHS, although Mark could point out that
> there is more to the concept than the PFI. In the NHS, the PFI has been an
> extraordinarily bad deal, and was lambasted as to its effect by the
> Conservatives before they took power last year (although it was their
> policy, dating from the early 1990s). What do we have to learn about the
> PFI, and wider 'public-private' deals, before we export...? Or is it just
> about hard cash?
>
> Another opportunity is that "many governments in the developing world
> admire our primary care system of GPs and local surgeries....". Now is
> this the traditional UK model of primary care, or the English one after it
> had been re-re-re-organised out of its wits by ever-increasing waves of
> 'market reform.' I think we should be told, Mark!
>
> Another is "a wealth of expertise in health data services and management
> knowledge..." and the  "National Institute for Health and Clinical
> Excellence." Call me a pie-eyed altruist, but should we not be helping
> countries with advice on the latter - if they so wish - as good world
> citizens. And regrading the former, let's clarify that we are not talking
> about the multi-billion 'white elephant' formerly known as the National
> Programme for Information Technology, another 'public-private partnership'
> which has had the English NHS over a barrel since it crashed and burned by
> reference to its original aspirations.
>
> I'll leave it at that. In the 1990s, during the NHS 'internal market',
> what from memory was called NHS Overseas Enterprises set about exporting
> elements of these reforms before they had been evaluated - or even fully
> implemented. Poor African nations are tiny Caribbean islands were
> astonished to hear about the 'purchaser/provider split' as the answer to
> their problems! I hope lessons have been learnt....
>
> Contrast the ethos of the above with the approach of the US Veterans
> Health Administration, which was willing, I have been told on US visits,
> to share its Electronic Patient Record approach - 'for love not money'
> (indeed I believe that, as a federal department, it is not allowed to blur
> its mission).....a pity the English  NHS had not listened to alternatives
> to its 'IT' approach at the time (see above.)
>
> Even were some of Mark's breathless list to be validated, what
> consideration is given to how, and under what circumstances, it is
> possible, just possible, to transplant policies and management
> initiatives?
> I do not want to come over all old-fashioned, but come off it, Mark. Some
> modesty, please.......!
>
> Calum Paton
>