National health goals cannot be achieved without local action

By Rachel Rowson

The priorities of every local NHS organisation in England have been uncovered for the first time in a report published by Health Mandate, giving a unique insight in to the Department of Health’s World Class Commissioning process. Local commissioning is becoming increasingly important, as the Government moves away from national targets and towards greater local autonomy. About 80% (£80bn) of the total health budget is spent directly by PCTs, so what they prioritise is a matter of intense public interest.

The report reveals that NHS bodies have embraced the prevention agenda with enthusiasm, addressing key public health issues such as smoking, alcohol and obesity. 68% of PCTs have identified reducing smoking rates as one of their key priorities; nearly half (49%) are focused on reducing the number of hospital admissions caused by alcohol; and 47% are concentrating on reducing childhood obesity despite the Department of Health itself not listing this as one of the priority options that PCTs choose from. However, not all PCTs are addressing the issues which appear to be the most pressing health problems in their community. For example Hull PCT, which has the highest smoking prevalence in England, is not focussing on smoking cessation.

It is also notable that there appears to be no consistent process for translating national political priorities into reality on the ground for patients, calling into question the extent to which politicians will be able to deliver on national promises in an era of increasing localisation. Some national priorities are available for local PCTs to adopt as indicators, whilst others are not. And there is no clear rationale as to why.

As the health service enters a period of relative thrift, it is notable that few PCTs are focussing on short to medium term efficiency savings. Out of the 54 priorities defined by the Department of Health only six relate to improving service efficiency or reducing ineffective spend. This disconnect between national priorities and local action is concerning given that the Budget 2009 made clear that the World Class Commissioning programme is expected to deliver significant efficiency savings, helping the NHS adjust to a more challenging public spending environment.

It is still early days for the World Class Commissioning programme but analysing the priorities adopted by PCTs through the process provides an inavlauble insight into the issues which will be occupying local commissioners in the coming year. As the transition from national target setting to local performance management continues, now is the time for all those with an interest in the future of the NHS to consider how best political priorities can be translated into delivery for patients. This report provides a useful resource to kick off the debate.