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Health authorities make equity of access their goal access their goal

Sixty per cent of health authorities regard equality of access as a key guiding principle, and four in ten give equitable services as an overall aim, a new analysis of the strategy plans of 66 HAs reveals.

The study, by Sharon Redmayne of the University of Bath, argues that HAs are ‘unanimous in planning for a primary care led NHS’. They view hospitals as becoming ‘institutions of last resort’, with increasing decentralisation of services.

There is a clear trend towards developing longer term, stable relationships with a smaller number of providers-a move which fits in well with Labour’s proposals for ‘comprehensive healthcare agreements’.

Similarly, over half the HAs studies have introduced some decentralisation of decision-making and commissioning of care, or are planning to do so. While there are a wide variety of models for locality commissioning, the overall movement is unmistakeable.

Health authorities remain reluctant to grasp the nettle of rationing. Although more HAs had introduced some explicit rationing of services than was the case in the previous year, the excluded procedures were still low volume, marginal operations such as tattoo removal or buttock lift. It seems that, on the whole, managers are happy to leave it to clinicians to decide who should get what.

But the report criticises HAs for the wide variability in the quality and quantity of information included in the strategy documents, saying they are inadequate as instruments of public accountability. And few HAs spell out how their plans will actually translate into the distribution of resources in future years.

The evidence of the study suggests that purchasers have moved away from the competitive rhetoric of the internal market and instead are using contracting simply as a tool for longer-term planning, say Patricia Day and Rudolf Klein in their introduction to the report. There is an inevitable tension between efficient planning and consumer choice.

‘Political rhetoric, in this respect, lags behind the NHS reality’ they argue.

Reshaping the NHS: strategies, priorities and resource allocation. From: NAHAT, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ. £22.