NHS competition plans provide focus for dissent

pharmafile | March 3, 2011 | Feature | |  Health and Social Care Bill, NHS, NHS reforms 

Confusion and controversy surround the government plans to introduce greater levels of competition into the NHS, with many stakeholder groups fearing that competition on price would not help improve patient care, and could be damaging or even dangerous.

NHS chief executive David Nicholson and health secretary Andrew Lansley have reiterated that it will be quality not price which will be the basis for competition, but many fear the system will work otherwise in reality.

The health secretary appeared before the cross-bench committee of MPs currently scrutinising the Health and Social Care Bill on 10 February. He told the committee: ‘‘Quality is the basis of competition, because those who make the choice – the patients – will be choosing on the basis of quality. Why would they do otherwise, since the service will be free to them?”

Lansley said information provided to patients would be about the quality of the services available to them, and that commissioners would focus on quality, and would have a duty to improve the quality of the service provided.

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A ‘quality premium’ would provide an incentive within the system

Despite these reassurances, numerous groups have expressed concern about the bill as it currently stands.

Among those criticising the current draft legislation is the NHS Alliance, which represents GPs and other primary care health professionals, it says a poorly thought out and badly implemented reform could have significant consequences for the NHS and its patients.

Michael Sobanja, chief executive of the NHS Alliance, said: “Clinically-led commissioning, as proposed in the Bill, provides the best chance for the NHS to deliver a truly integrated care for its patients, where local needs are fully met. This is something we have long campaigned for, hence the full support we have shown the government’s reforms over the past months.

“However, some key aspects of the Bill leave open the possibility that service may become less integrated, less accountable, less fair and less transparent. So we need to make sure these are fully addressed.”

Sobanja was one of several experts who gave evidence on to the committee of MPs charged with scrutinising the Bill.

The NHS Alliance is calling for clear, written commitments from the government on three key issues:

Competition: Competition should be used to stimulate greater integration of services and not fragment them. Specifically, the ‘Any Willing Provider’ should be a policy which ensures that commissioners are able to nurture effective collaboration between diverse, innovative, high-quality providers – and not a general policy which can be used to flood the provider market and undermine commissioning based on local needs.

Public accountability: Commissioning should remain both now and in the future, publicly accountable, a function that should be undertaken by statutory bodies acting on behalf of and accountable to, local communities.

Making a commissioning-led NHS a reality: The NHS Alliance says rhetoric about a commissioning-led NHS must be cemented in reality, with commissioners required to work with providers, but also to hold ultimate responsibility and authority to meet local needs. It says regulators should support commissioning needs, and calls for the national commissioning board to adopt a ‘truly enabling and empowering’ management style.

The Alliance also says the government should remove any tensions between section 24D of the Bill (the clause requiring practices to act in a manner consistent with consortia policy) and the duties conferred on individual GPs by the GMC and the contractual elements of practice-held contracts (GMS, PMS and others).

Finally it wants to see the adoption of maximum tariff pricing – i.e. allowing providers to compete on price – to be used only when the quality of a service can be guaranteed.

Mr Sobanja said he believed the ‘direction of travel’ was absolutely right, but that the reforms needed to ensure the interests of public and patients came first. Other issues of accountability; equity and transparency also needed to be enshrined in the legislation.

Andrew McConaghie

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