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How the coalition is shaping up

Practical Commissioning editor Sue McNulty takes stock of events so far

Over a post-election cuppa with Practical Commissioning's editorial board I suggested it would be weeks, if not months, before the new health secretary's policy started to emerge.

‘If he's going to make £20bn savings by 2014, he hasn't got that long,' came the blunt reply.

To avoid 1980s-style salami-cutting in a couple of years' time, Andrew Lansley needs to initiate considered savings now. Sure enough, the coalition agreement was published ahead of schedule. A first.

The Department of Health is fortunate to have Mr Lansley, who already has seven years as shadow health secretary under his belt.

Terms such as ‘payment-by-results' roll off his tongue in interviews where other new health secretaries at this stage would have only just been briefed on the difference between primary and secondary care.

Health wasn't up there in the ‘top three' election battleground issues this time. But even though the election is over there is still a campaign to be won – to convince the country a coalition government can work.

The DH is a department that can make policy quickly at a time when the public wants reassuring. And healthcare can be very reassuring for the granny in Basildon or the expectant mother in Hackney in a way that defence or transport are not.

Enough politics (for now). Let's talk about what was – or rather what wasn't – in the coalition document.

The term ‘real budgets' wasn't. The document says the coalition Government ‘will strengthen the power of GPs as patients' expert guides through the health system by enabling them to commission care on their behalf'.

If real budgets are coming – and everyone I speak to says they are – we need a document telling us how they're going to work. There is no developed sense of how real budgets might work in PBC yet, even though several PCTs are working with local clinicians towards them. Or is the Government waiting to incorporate responsibility for commissioning in the new GMS contract it plans to negotiate?

Real budgets and the greater involvement of the private and third sector emerge as the strongest battleground areas in our dissection of the coalition document.

Greater scope for the private sector was not a Liberal Democrat policy; indeed before the election the party wanted elected health boards to stop any private sector bias.

The document is to be welcomed but there is still a lot of detail to come. We asked those at the commissioning coalface what they will be looking for from the new Government.

Finally there is out-of-hours. The document talks of a 24/7 urgent care

service. If the coalition wants a good example of how this would work, it should read about East Lindsey. GPs are not only commissioning out-of-hours, they are also now providing the inpatient bed care.

Worth a ministerial visit?

Andrew Lansley MP