MPs back plans to sweep away NHS competition rules
Author: Mark Gould
The influential House of Commons Health and Social Care Committee has backed plans to sweep away NHS competition rules in order to improve collaboration and integration of NHS and social care.
In its report* published today the Committee says it believes that collaboration, rather than competition, is a better way for the NHS and the wider health and care system to respond to today's challenges.
It says competition rules add costs and complexities, without corresponding benefits for patients and taxpayers in return. It adds that choice and competition can help raise standards and encourage innovation, “but, as an organising principle, collaboration is a better way to manage the rising demands on health and social care, improve joined up care for patients and deliver better value for taxpayers”. However, the report says the NHS should not become a monopoly as this would not be in the best interests of patients.
The report also recommends that the law should rule out non-statutory providers holding an Integrated Care Provider (ICP) contract. Until the law is changed, the Committee strongly urges that any ICP contract should be held by an NHS body.
In addition, the Committee supports the proposal to give the secretary of state powers to create new NHS trusts, but this power must not be used by the Department or national bodies to impose a form of integration on local health and care services or as threat to force organisations to collaborate.
It does not think that the time is right for integrated care systems to be established as separate legal entities as experts told the Committee that doing so would involve far wider legislative changes and there is no appetite for another major reorganisation of the NHS. These new systems must however demonstrate the highest standards of openness and transparency.
It calls for the NHS at a national level to "support, encourage and empower local leadership".
"Local areas are working hard to collaborate and integrate care around patients but too often having to do so in spite of rather than with assistance from current legislation which is why legislative changes are necessary to remove some of the hurdles," the report states.
While the Committee supports – in principle – the proposal for NHS England and NHS Improvement to merge, concerns have been raised about the degree of central control that could result from this merger. The Committee would like to see more detail on how any unintended consequences of this merger will be avoided.
Committee chair Dr Sarah Wollaston, who is a former GP, says: "The pragmatic proposals we heard throughout this inquiry are broadly welcome. This report also represents cross-party endorsement of suggested changes, and presents an opportunity to make integration easier, to encourage greater collaboration and reduce some of the burdens from competition rules.
"Nevertheless, the proposals in their current form are NHS-centric – we would like to see greater consideration of the wider system which the NHS seeks to integrate.
"It is clear that there is no appetite for another large-scale, top-down reorganisation of the NHS and within the current hung Parliament any such major change would not pass the House of Commons. These proposed reforms are being led by the NHS itself and I hope will receive cross party support.
"Local health providers continue to work to collaborate and integrate care around patients, in spite of current legislative obstacles and these proposed reforms are designed to remove some of the barriers that can get in the way
"We hope the incoming prime minister will support the need for reform and that a commitment to take this forward will form part of the next Queen’s Speech. The Committee looks forward to conducting pre-legislative scrutiny."
Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said: “There is no appetite for another top down reorganisation in the NHS at the moment – that may be needed down the line but front-line leaders and staff have enough to do without such a distraction. But as the Committee rightly recognises, we do need some targeted changes in the legislation to help staff deliver improvements in patient care and also because we have run out of workarounds. These are a sensible set of proposals.
“Our big worry in the NHS England/Improvement proposals was what looked like a move to greater centralisation – even if that isn’t the intention. We all want local NHS organisations to work more collaboratively but that will not happen by stripping away local autonomy and giving more powers to the centre.
“And while we support the Committee’s view that NHS England/Improvement should come together under a single national leadership, we share its concerns that the centre could become too powerful. That’s why we are pleased the MPs agree that the centre should not start to direct mergers, acquisitions and the capital spending limits of foundation trusts.
“Finally, this is difficult to resolve but the Committee’s proposals do not deal with the ambiguity and tension that will remain in the system when it comes to the governance and accountability of local NHS organisations. Both trusts and CCGs [clinical commissioning groups] will face tension between the hard accountability they face to their governing bodies under the current arrangements, and their new responsibilities which will require them to play a more involved role in their local systems.
“But we need to be realistic about how much legislation can achieve and indeed whether it is achievable. Our members have consistently told us that their ability to deliver greater collaboration will be down to relationships and leadership – and you cannot legislate for either of those.”
*NHS Long-term Plan: legislative proposals. A report prepared by the Health and Social Care Committee, 24 June 2019.