Sending shockwaves through the NHS?

Sending shockwaves through the NHS? Taken at face value, Simon Stevens’ recent remarks to the Public Accounts Committee should be sending shockwaves through the NHS. Six to ten sustainability and transformation plan (STP) areas, to be announced in the forthcoming Forward View delivery plan, are set to become ‘accountable care organisations or systems, which will for the first time since 1990 effectively end the purchaser–provider split, bringing about integrated funding and delivery for a given geographical population’. 

It would be hard to overstate the magnitude of such a shift in policy, if that is what we are witnessing. Since the early 1990s, governments have pinned their hopes on purchaser–provider separation as the basis for health care improvement. Simon Stevens’ comments reflect, in large part, a growing perception that the costs of the purchaser–provider split outweigh the benefits of the market it was supposed to create. Transaction costs are high. Meanwhile, the market has delivered, at best, only modest efficiencies. Demographic and epidemiological changes are driving integration, which makes arm’s-length contracting even harder.  The King's Fund