Commissioning of specialised services is done across the region. I had to drive to another county for the meeting where we were going to decide what to invest in. These are low volume high cost services currently costing about £600 million for our region. Historically it has had double digit inflation. That isn’t sustainable.
The night before, along with a GP, I facilitated a group of fifty sixth formers in deciding what specialised services they would commission. We got them into small groups and gave them sheets (A3 bingo cards) with 10 services they could buy, each costing £1 (if only!) and a short description of the numbers of people and benefits they would get from investing in the service. The catch was they only had £8 to invest and had to decide which two services would miss out. What did stop me in my tracks was the sixth former who put up her hand and asked, “Can you really cure unhappiness by giving someone a penis?” A good question.
The exercise sparked a vigorous debate ranging across ethics, eugenics, politics, the media and how on earth you make such decisions. What was interesting for me was how consistent their choices were across the 10 services. Their choices were the same as those made by fifty women from the WI last year when we ran the same exercise. The majority wouldn’t invest in IVF or gender change surgery.
They weren’t the ones we made at the Specialised Commissioning meeting. The ones the sixth formers and the WI chose not to invest in would draw the wrath of clinicians, politicians, media and lawyers (sex discrimination and the European Court of Human Rights) down upon our heads. So we pored over data and benefits analysis, argued, and pondered (occasionally pontificated) and gauged how far we could go without provoking more trouble than we could cope with – or survive. Realistically we might be able to get inflation down to 5%, much more if we could take the hard decisions we want to take.
Could we have an intelligent public debate about this? Is there a political will to support tough decisions? Would the media just turn it into scary and sensational headlines? Answers in June please.
Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.