Ash

You can have many types of efficiency. Sure, you can have health outcomes-based efficiency. You can also have activity-based efficiency (what you seem to define as productivity but what i would term productive efficiency). If my objective is to balance peanuts on the end of my nose, I can have efficiency over that as well. To me (although many disagree with me on this), generating health outcomes is not and cannot be the only purpose of a health care system. People in this country have historically been concerned with waiting times. Labour were actually tremendously successful at reducing those, and I don't know why they didn't make a bigger deal of that at the last general election. I agree that the previous government could have done a heck of a lot better. But they did some things reasonably well.

If you are bothered with only health outcomes efficiency, well labour did introduce NICE. Also, process based efficiency is ok to that aim if the process measures can be expected to improve health outcomes. But, as I implied, I think a great deal is potentially lost if you restrict yourself to health outcomes (especially health outcomes maximisation).

Best,
Adam


On 1 Aug 2011, at 22:17, "Ash Paul" <[log in to unmask]> wrote:

You are abs right Adam, it was meant to improve efficiency, but unfortunately the politicians and the NHS managers and clinicians did not/still do not understand that efficiency and productivity are as different as chalk and cheese, and glibly use the words interchangeably and wrongly, which is why commissioning has underperformed so badly.
Productivity is output divided by input whereas efficiency is outcomes (ie healthgain in health care) divided by input.
Unfortunately Labour was obsessed with productivity, whereas it should have been obsessed with efficiency right from the beginning. This did not matter so much when the NHS money was rolling in, but now it does. The NHS commissioners should be insisting on increased outcomes for their ever dwindling resource input. This will start to get rid of the huge waste in the NHS. To be fair to Andrew Lansley, he has realised this fatal flow in the NHS and one of his proposed planks is payment by outcomes, not payment by results (or payment for each item of service). My great fear is that this government may not get the definition of outcomes right. It needs to be looking for patient oriented outcomes (POOs) and NOT disease oriented outcomes (DOOs). The moment you start looking for DOOs, you are onto a hiding to nothing and you can't put a stop to the waste in the NHS.
Regards,
Ash
 
From: "Oliver,AJ" <[log in to unmask]>
To: [log in to unmask]
Sent: Monday, 1 August 2011, 21:38
Subject: Re: "Reducing spending on low clinical value treatments"

It wasn't about creating a commercial market at all. It was about creating incentives to improve efficiency. It may not have worked that well (it worked a


On 1 Aug 2011, at 21:14, "Alex Scott-Samuel" <[log in to unmask]> wrote:

Stories such as this one suggest the situation has gone beyond that which you describe Ash:

http://www.independent.co.uk/life-style/health-and-families/health-news/cataracts-hips-knees-and-tonsils-nhs-begins-rationing-operations-2327268.html

The unnecessary invention of commissioning / purchasing was solely about developing a commercial market in health care. Public health doctors who enjoy clinical epidemiology should work in hospital based teams with clinicians - who should have the final say in clinical decisions. Public health doctors who enjoy public health should work in properly funded local authorities

Alex

   

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