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Last Updated: Friday, 2 June 2006, 16:26 GMT 17:26 UK
Health economist's view
Spiralling debts and job cuts are plaguing the NHS in England, bringing a new focus to how it operates in the 21st century.

Health workers in a variety of sectors - plus the BBC's Home Editor, Mark Easton - offer their views on what is wrong with the National Health Service and prescribe their own remedies.

Chris Ham, Professor of Health Policy and Management, Health Services Management Centre, University of Birmingham, gives his assessment.

DIAGNOSIS

The NHS has made huge progress since The NHS Plan in 2000 and its performance has improved on almost all indicators.

Last year's deficits have taken the gloss of the progress that has occurred but these should not detract from a solid record of achievement.

The big challenge is whether progress can be sustained as the NHS tackles its deficits and whether the next stage of reform can be implemented in a way that brings long term benefits.

Cuts in some NHS organisations and the controls placed on commissioning in the current year mean that is unlikely that waiting times will continue to fall at the same rate.

It will also be difficult to improve services beyond the top six priorities identified by the Department of Health.

The next stage of reform will create further instability as choice, payment by results and independent sector treatment centres play a bigger part.

The prime minister has already recognised this and warned that this is a year of transition in which difficult adjustments will have to be made.

PROGNOSIS

The government needs to give priority to three issues in the coming year.

First, this should be the year in which commissioning is given serious attention, both in designing a coherent commissioning function, and in supporting commissioners to negotiate on equal terms with providers.

Second, the balance of financial incentives should be reviewed.

Payment by results promises to support further improvement in access and responsiveness.

But for unplanned care, and care for people with long term conditions, it is unlikely to promote the integration of services that is needed.

Third, the responsibilities of the regulators and of NHS bodies in market management must be clarified.

The reforms are already leading to discussions of mergers and acquisitions and yet there is no agreed framework or process for resolving these.

The policy vacuum needs to be filled rapidly to give confidence that the system architects have thought through the consequences of the reforms they have initiated.



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