Market competition is stifling vital innovation in our NHS
It is increasingly clear that any government coming into power after the next election will be faced with unprecedented challenges across the NHS.
The legacy of five years of government-imposed austerity and top down restructuring is a growing financial crisis, with even our best performing hospitals sliding into deficit, staff morale at rock bottom and performance plummeting. If things remain this way, the NHS is now predicted to be facing a funding gap of £30bn by the end of the next parliament.
Enter the Five Year Forward View, NHS England’s blueprint for the future funding and delivery of services that aims to meet these challenges. The plan calls for an additional £8bn of government funding combined with efficiency savings of £22bn.
To put this in perspective, the NHS will be asked to find efficiency savings of around 3 per cent a year, compared to a long term trend of 0.8 per cent. While advocates point to significant savings made in recent years, this has been almost entirely predicated on cuts to tariffs and wages that are simply not sustainable.
Everyone seems to agree. Something new must be done. The Five Year Forward View believes the solution lies in new models of care, integrating primary and secondary care, along with social care, community services and mental health, delivered in an integrated and accessible way in new settings, whether in GP surgeries, hospitals or elsewhere.
While there remains considerable doubt whether integrated models of care will provide cashable savings, few would disagree that there are tangible benefits to patients through greater collaboration and integration across all parts of our health and social care system.
Which is where we begin to encounter problems arising from the complex, damaging and wasteful reforms brought about by the Health and Social Care Act. Because collaboration, integration and long-term planning don’t sit easily with this government’s zeal for market competition, embodied in the procurement and commissioning guidance handed down by Monitor and NHS England.
29 ‘vanguard sites’ have been selected across the country to pilot the new models of care. They need time, resources and the ability to integrate and plan effectively. As such, many are now calling for a moratorium on tenders.
The Health Service Journal reports that CCGs and provider Trusts involved in the vanguards are calling for NHS England and Monitor to ensure that services are not forced out to competitive tender, thereby scuppering attempts to foster closer integration and collaboration between existing providers.
Many of the vanguards include the integration of community services, the area of the NHS that has been most exposed to outsourcing. That is why those involved in the Calderdale pilot have called for NHS England to provide “cover to health economies to enable partnership working to develop”, that the Chief Executive of South Warwickshire Foundation Trust believes that it would be “sensible to step back from traditional procurement processes to let these models to develop” and why the Chief Executive of Birmingham Community Healthcare Trust argues that “if they choose to put community services out to tender … they are in danger of cutting completely across the opportunities that the vanguard sites will develop”.
It is hard to under-estimate how important the development of new models of care, based on collaboration and integration, could be for the future of our NHS. Yet they are in danger of being strangled at birth by free market fundamentalism that is the enemy of innovation and change.
Predictably, NHS England and Monitor have refused to budge. NHS England believes that a moratorium on commissioning would “not be helpful”.
However, Monitor offer some sort of hope in that “the procurement regulations and other relevant legislation remain in force until such time as Parliament decides otherwise”.
Now there’s a thought …