NHS Alliance takes on reform

Civitas, 26 October 2009

The pre-election season seems to have ignited a raft of prescriptions for fixing the NHS, and this is a good thing. In a new report entitled ‘Rebalancing the market,’ the NHS Alliance echoes the recent DH endorsement of the NHS as the market’s ‘preferred provider’, but it presents a different rationale.

The report, available from the Alliance press office, suggests Primary Care Trust tendering should consider private bidders only when there are no current NHS providers of sufficient quality or conventional GP services available at the right price. The similar position of the DH was clarified in a 13 October letter to PCTs and SHAs, which stated the intention to set out a clearer process for commissioning that will ‘provide an opportunity for existing NHS providers to improve before opening up to new potential providers’.

The primary reason the Alliance gives is a good one: it has been repeatedly shown that care quality is improved by use of integrated service pathways, which are difficult to implement when the necessary treatments are provided by various unconnected organisations. By contrast, the reasoning behind the government’s change of heart on competition is not completely clear. Union support is certainly needed with the upcoming election, but is this the sole impetus for such a drastic turn-around? The only other justification provided seems to appear in the phrase: ‘This [policy] is fair to all as it means everyone knows where they stand and services stand or fall on the quality they provide.’ Is blatantly supporting the NHS a fair set-up? Something tells me independent providers might disagree.

Interestingly, both the DH and the NHS Alliance seem to want to keep private providers around as a threat, as if to say to NHS organisations, ‘If you do not perform to standard, we’ll bring in the bad guys…’ (The government has not done anything to suppress prevailing suspicion of the private sector among patients and physicians alike). The DH letter states: ‘We remain committed to the participation of independent and third sector providers where this is the right model for patients – for example, where we need new services/service models, or substantial increases in capacity, or to offer increased choice to patients or to stimulate innovation.’ The Alliance says policy should ‘encourage competition where services are of insufficient standard or too expensive, without destabilising primary care provision when it is already good.’ They even go as far as saying PCTs or SHAs should provide formal support to NHS bidders.

But the question remains—where do they expect these independent providers to appear from when they decide the local NHS is not providing services of high enough quality or needs a little boost of innovation? An environment that is predominantly in favour of the NHS, both in sentiment and policy, is not going to attract new providers to enter the market, never mind wait around for their services to be of use. Companies and investors are smarter than that.

And if they do go this route, NHS patients who then find themselves in the care of a private organisation might begin to question why.