Liberating the NHS; commissioning, outsourcing and a new politics debate

Regan, Paul; Ball, Elaine

doi:10.12968/bjcn.2010.15.10.78746

Cited by 4 publications

(6 citation statements)

References 2 publications

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“…The global financial crisis of 2007/ 2008 led to a concern for the NHS and the direction which the government, through a number of Lord Darzi's consultations, were attempting to take it (Regan & Ball, 2010). At the time it was felt that the commissioning agenda had been a new innovation to what was considered a funding crisis for the NHS (Tallis &Davis, 2013).…”

Section: Thirty Years In the Makingmentioning

confidence: 99%

“…This view developed significantly from our initial publication in 2010 discussing a new politics of morals for the common good (Sandel, 2009) in this journal and the "soft" target of community nursing through commissioning services (Regan & Ball, 2010). Although not complete by any standards, the shift towards market liberalisation and for-profit healthcare services contracted by the NHS has been a steady process of attrition (Tallis & Davis, 2013).…”

Section: Introductionmentioning

confidence: 99%

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NHS market liberalisation and the TTIP agreement

Regan

Ball

2016

Br J Community Nurs

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Community nurses have perhaps more than most felt the effects of commissioning as services reduced to what is made explicit contractually. Commissioning was rolled out as the solution to the global financial crisis in 2007/8 that directly impacted on the cost of the NHS and at the time the mantra was to accept service re-configeration and be fit for commissioning purposes. We suggest, in contrast, successive governments' over the past thirty years have been less than candid about their true intentions to reform the NHS. Instead of reforms to improve productivity, quality and cost efficiency, the agenda had all along been to introduce the NHS to market liberalisation, along the same lines as the United States model of healthcare. This agenda aimed therefore to move the NHS from being publicly owned and the next stage is further market liberalisation of the NHS through the trans-Atlantic investment partnership. This means the public's health, once again, will be subordinate to the "rights" of corporate healthcare industries to profit from the NHS.

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Section: Thirty Years In the Makingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

NHS market liberalisation and the TTIP agreement

Regan

Ball

2016

Br J Community Nurs

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“…Interestingly, the role of NICE in the National Health Service (NHS), which is highly prescriptive, has been questioned. NHS essentially is turning away from NICE and attempting to empower physicians in a major shift in the policy since its inception (156)(157)(158)(159)(160)(161)(162)(163)(164)(165)(166)(167)(168)(169)(170)(171). In addition, Cochrane reviews, NICE, AHRQ, and other organizations are becoming commercialized with limited clinician input and methodologically focused evaluations, essentially creating a shadow governance of health care.…”

Section: E52mentioning

confidence: 99%

Patient Protection and Affordable Care Act of 2010: Reforming the Health Care Reform for the New Decade

Manchikanti

Caraway²,

Parr³

et al. 2011

Pain Phys

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The Patient Protection and Affordable Care Act (the ACA, for short) became law with President Obama’s signature on March 23, 2010. It represents the most significant transformation of the American health care system since Medicare and Medicaid. It is argued that it will fundamentally change nearly every aspect of health care, from insurance to the final delivery of care. The length and complexity of the legislation and divisive and heated debates have led to massive confusion about the impact of ACA. It also became one of the centerpieces of 2010 congressional campaigns. Essentials of ACA include: 1) a mandate for individuals and businesses requiring as a matter of law that nearly every American have an approved level of health insurance or pay a penalty; 2) a system of federal subsidies to completely or partially pay for the now required health insurance for about 34 million Americans who are currently uninsured – subsidized through Medicaid and exchanges; 3) extensive new requirements on the health insurance industry; and 4) numerous regulations on the practice of medicine. The act is divided into 10 titles. It contains provisions that went into effect starting on June 21, 2010, with the majority of provisions going into effect in 2014 and later. The perceived major impact on practicing physicians in the ACA is related to growing regulatory authority with the Independent Payment Advisory Board (IPAB) and the Patient Centered Outcomes Research Institute (PCORI). In addition to these specifics is a growth of the regulatory regime in association with further discounts in physician reimbursement. With regards to cost controls and projections, many believe that the ACA does not fix the finances of our health care system – neither public nor private. It has been suggested that the Congressional Budget Office (CBO) and the administration have used creative accounting to arrive at an alleged deficit reduction; however, if everything is included appropriately and accounted for, we will be facing a significant increase in deficits rather than a reduction. When posed as a global question, polls suggest that public opinion continues to be against the health insurance reform. The newly elected Republican congress is poised to pass a bill aimed at repealing health care reform. However, advocates of the repeal of health care reform have been criticized for not providing a meaningful alternative approach. Those criticisms make clear that it is not sufficient to provide vague arguments against the ACA without addressing core issues embedded in health care reform. It is the opinion of the authors that while some parts of the ACA may be reformed, it is unlikely to be repealed. Indeed, the ACA already is growing roots. Consequently, it will be extremely difficult to repeal. In this manuscript, we look at reducing the regulatory burden on the public and providers and elimination of IPAB and PCORI. The major solution lies in controlling the drug and durable medical supply costs with appropriate negotiating capacity for Medicare, and consequently for other insurers. Key words: Affordable Care Act, health care costs, health care regulation, health care reform, Patient Centered Outcomes Research Institute, health exchanges, health care subsidies, health insurance premiums, uninsured, Medicare, cost control

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“…Political interference has had a significant influence on the future of health visiting, and not for the public good [8]. The expansion of commissioning [5] appears to have been instrumental in the professions reduced capacity to tackle health inequalities. This was evident in 2006/07 when PCT's failed to fund enough training (329 in spite of 798 applicants) [33].…”

Section: Political Influencementioning

confidence: 99%

“…As well as the McKinsey report [4], the threat to remove health visitors' registerable qualification in the year 2000 should have rang alarm bells much sooner. The expansion of commissioning, with international healthcare providers being allowed to tender for NHS services paid for by the UK taxpayer [34] adds to the risk of slow implementation of NICE guidelines and well funded local action [5].…”

Section: Political Influencementioning

confidence: 99%

Listening Visits to Mothers’ Suffering with Mild to Moderate Peri-Natal Depression; Critical Issues of Clinical Supervision, Training and Health Visiting Capacity to Tackle Health Inequalities

Regan¹

2011

Prim Health Care

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The importance of United Kingdom health visitors' in the detection and treatment of perinatal depression in primary care services is well documented. Evidence based policy and clinical guidelines make recommendations for the prediction, detection and treatment of women with mild to moderate depression in the postnatal period continuing up to a year after delivery. An inter-professional cross organisational practice development project aimed to assess the provision of antenatal and perinatal mental health care within one health visiting service in accordance with NICE guidelines (2007). This paper discusses the disparity between guidelines and health visiting practice; a lack of training in listening visits or other psycho therapeutic methods, poor access and availability of clinical supervision, commissioning reforms leading to larger health visiting caseloads suggesting the service is unable to meet NICE recommendations. Lastly, the evidence suggests the scope and practice of community nurses' within health visiting teams should be expanded.

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Liberating the NHS; commissioning, outsourcing and a new politics debate

Cited by 4 publications

References 2 publications

NHS market liberalisation and the TTIP agreement

NHS market liberalisation and the TTIP agreement

Patient Protection and Affordable Care Act of 2010: Reforming the Health Care Reform for the New Decade

Listening Visits to Mothers’ Suffering with Mild to Moderate Peri-Natal Depression; Critical Issues of Clinical Supervision, Training and Health Visiting Capacity to Tackle Health Inequalities

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