One of the interesting exchanges in a debate about NHS world-class commissioning and social care personalisation policy was between Jon Glasby (the Birmingham health policy academic) and Jeff Jerome (the new social care ‘transformation’ tsar). Glasby pointed out that trying to improve service quality by using the power of money in the commissioning process (the NHS approach) was inconsistent with giving priority to service user wishes by giving them the money or the budget to spend on services they preferred (the social care approach). We have already seen people saying that service users’ focus on their own priorities means they may not provide for the development of staff training and skills, health promotion policies and anti-discrimination objectives.

Jerome pointed out that this would lead to the NHS aiming for improvements that met policy and professional aims for a ‘world-class’ service while the social services couldn’t aim for the same things unless their users wanted it. This was, he said, a tension.

Peter Beresford, the service user guru, in another part of the debate, squared the circle, by saying that it wouldn’t be world-class unless it responded to what service users wanted. This is obviously true, but could only be said in social care, because the NHS is too politically important for policy and professional judgement not to play a strong part.

Community Care (2008) Commissioners must unleash creativity. In M Samuel (ed.) World Class Commissioning in Social Care. Supplement to Community Care 29th November 2008: 8-10.

This also affects cancer and palliative care. Cancer is one of those healthcare areas where really high-quality medical intervention makes a major difference to outcome, so obviously ‘world-class’ commissioning is going to focus on medical priorities. But palliative care aims at ‘holistic’ care with a strong social and spiritual element, aiming to be responsive to what people want when they pass beyond the cure priority. You can’t help feeling that this will mean that the NHS will need to spend most of its cash on word-class cancer treatment in high-tech hospitals and will have less to spend on good palliative care afterwards. It’s a compliment to the cancer plan and later policy documents that there has been something of a focus on palliative care in the face of this pressure.

However, I wonder what will happen when, as my newspaper proudly trumpeted this morning, the majority of hospitals are now foundation trusts. The fuss when the government tried to tell foundation hospitals earlier this year that, like all others, they must have a deep-clean reminds me that the government has not yet found a way of getting foundation trusts to comply with political or public priorities.