NHS heading for more competition under coalition: Despite the rhetoric around integrated care, the market-oriented thrust of the NHS reforms seems to be the only show in town.
The political battleground over the future of the NHS is now taking a recognisable shape – the coalition supports competition while the Labour Party supports integration.
The coalition claims that the imperatives are not mutually exclusive, and trumpets the virtues of both. But newly published procurement regulations, due to take effect in April, expose the reality about where the NHS is heading.
The regulations follow a consultation last year on securing best value for NHS patients, and the response document suggests that little change has been considered necessary.
Although they claim: "the starting principle is for commissioners to decide how best to secure services for their populations," the regulations go on to tie down clinical commissioning groups hand and foot.
For example:
• All providers must be treated equally, "particularly on the basis of ownership".
• Commissioners "must not engage in anti-competitive behaviour" and should "not include any restrictions on competition that are not necessary".
• A contract can only be awarded without competition "for reasons of extreme urgency".
None of this will embolden local health and wellbeing boards to plan for integrated care across their areas.
The 2012 consultation proposed an indispensability test that stated: "restrictions to competition will not be in the interests of people who use healthcare services unless they are indispensable to the attainment of the intended benefits for people who use these services." That's a high hurdle to clear.
And local commissioners will take little comfort from the post-consultation decision to replace the term "indispensable" with "necessary".
For those sufficiently emboldened to proceed with non-competitive local strategic planning there is the prospect of a visit from Monitor, with its new wide-ranging powers to vary or withdraw anti-competitive tendering arrangements, and put measures in place stop them recurring.
And while the Department of Health claims to be interested only in principles not prescription, we are promised further detailed joint guidance from Monitor and the NHS Commissioning Board under the inviting title of the Choice and Competition Framework.
Last year in the final stages of the bill in the House of Lords, there was a move to add the prevention of anti-collaborative behaviour to the duties of Monitor, to ensure this had equal status with its duty to prevent anti-competitive behaviour. But health minister Earl Howe said this would be unnecessary.
He said: "where collaboration was in the interests of patients it would be regarded by Monitor as trumping the need for competition".
We can now see how shallow and misleading such assurances were. The NHS in England is now fully and unequivocally exposed to UK and EU competition law. It is hard to say where this leaves those keen on pursuing local service integration based upon statutory, third-sector and independent partners.
The fleeting hope has been the appointment of the Lib Dem health minister, Norman Lamb. There is no doubt Lamb would like to see a big push on integrated care, and it was reported last year that he was planning to support a series of large-scale integrated care experiments that could allow local health economies to devise their own payment systems and move away from the straitjacket of payment by results.
It was mooted that this could also involve an assurance that Monitor would not act to break up collaboration on anti-competitive grounds.
Such an approach would be a direct challenge to the new regulations on procurement, and it is maybe no surprise that the trail on Lamb's experiments have gone rather cold.
What must be disappointing to so many is that despite the rhetoric around integrated care following the pause in Lansley's bill, and the work of the Future Forum, the market-oriented thrust of the NHS reforms seems to be the only show in town.
The fact that there is no robust evidence base to support the idea that choice and competition in healthcare leads to better or more cost-effective outcomes is of no seeming consequence.
It is in the devilish detail of the regulations now being laid before parliament that the shape and direction of the NHS is being decided – and it is passing through almost unnoticed. Guardian Professional.
The political battleground over the future of the NHS is now taking a recognisable shape – the coalition supports competition while the Labour Party supports integration.
The coalition claims that the imperatives are not mutually exclusive, and trumpets the virtues of both. But newly published procurement regulations, due to take effect in April, expose the reality about where the NHS is heading.
The regulations follow a consultation last year on securing best value for NHS patients, and the response document suggests that little change has been considered necessary.
Although they claim: "the starting principle is for commissioners to decide how best to secure services for their populations," the regulations go on to tie down clinical commissioning groups hand and foot.
For example:
• All providers must be treated equally, "particularly on the basis of ownership".
• Commissioners "must not engage in anti-competitive behaviour" and should "not include any restrictions on competition that are not necessary".
• A contract can only be awarded without competition "for reasons of extreme urgency".
None of this will embolden local health and wellbeing boards to plan for integrated care across their areas.
The 2012 consultation proposed an indispensability test that stated: "restrictions to competition will not be in the interests of people who use healthcare services unless they are indispensable to the attainment of the intended benefits for people who use these services." That's a high hurdle to clear.
And local commissioners will take little comfort from the post-consultation decision to replace the term "indispensable" with "necessary".
For those sufficiently emboldened to proceed with non-competitive local strategic planning there is the prospect of a visit from Monitor, with its new wide-ranging powers to vary or withdraw anti-competitive tendering arrangements, and put measures in place stop them recurring.
And while the Department of Health claims to be interested only in principles not prescription, we are promised further detailed joint guidance from Monitor and the NHS Commissioning Board under the inviting title of the Choice and Competition Framework.
Last year in the final stages of the bill in the House of Lords, there was a move to add the prevention of anti-collaborative behaviour to the duties of Monitor, to ensure this had equal status with its duty to prevent anti-competitive behaviour. But health minister Earl Howe said this would be unnecessary.
He said: "where collaboration was in the interests of patients it would be regarded by Monitor as trumping the need for competition".
We can now see how shallow and misleading such assurances were. The NHS in England is now fully and unequivocally exposed to UK and EU competition law. It is hard to say where this leaves those keen on pursuing local service integration based upon statutory, third-sector and independent partners.
The fleeting hope has been the appointment of the Lib Dem health minister, Norman Lamb. There is no doubt Lamb would like to see a big push on integrated care, and it was reported last year that he was planning to support a series of large-scale integrated care experiments that could allow local health economies to devise their own payment systems and move away from the straitjacket of payment by results.
It was mooted that this could also involve an assurance that Monitor would not act to break up collaboration on anti-competitive grounds.
Such an approach would be a direct challenge to the new regulations on procurement, and it is maybe no surprise that the trail on Lamb's experiments have gone rather cold.
What must be disappointing to so many is that despite the rhetoric around integrated care following the pause in Lansley's bill, and the work of the Future Forum, the market-oriented thrust of the NHS reforms seems to be the only show in town.
The fact that there is no robust evidence base to support the idea that choice and competition in healthcare leads to better or more cost-effective outcomes is of no seeming consequence.
It is in the devilish detail of the regulations now being laid before parliament that the shape and direction of the NHS is being decided – and it is passing through almost unnoticed. Guardian Professional.
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