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Don't force NHS commissioners into unnecessary competition Don't force NHS commissioners into unnecessary competition
(6 days later)
I have always been a strong advocate that the NHS should be the "preferred provider" of NHS services. This is not down to ideological dogma or misty-eyed loyalty to public services, it is a belief based on the hard reality of what works best for our patients.I have always been a strong advocate that the NHS should be the "preferred provider" of NHS services. This is not down to ideological dogma or misty-eyed loyalty to public services, it is a belief based on the hard reality of what works best for our patients.
Having NHS providers deliver care helps produce a service where all parts of the many arms of our health service are properly integrated, particularly the important relationship between GP practices and hospitals. The cornerstone of good care is proper, joined-up collaboration where staff and patient are focused on one goal: better, more efficient care of the individual in need.Having NHS providers deliver care helps produce a service where all parts of the many arms of our health service are properly integrated, particularly the important relationship between GP practices and hospitals. The cornerstone of good care is proper, joined-up collaboration where staff and patient are focused on one goal: better, more efficient care of the individual in need.
Of course, it is not always the case that this happens automatically in the NHS. Silos are always a danger in any large, multifaceted institution. But ultimately, you are more likely to get the right environment for joined-up care if the providers come from the same public ethos and family.Of course, it is not always the case that this happens automatically in the NHS. Silos are always a danger in any large, multifaceted institution. But ultimately, you are more likely to get the right environment for joined-up care if the providers come from the same public ethos and family.
It is because of this belief that I have welcomed signs that clinical commissioning groups (CCGs) – who in April this year took over budget and commissioning duties for large swaths of the NHS – are keeping in mind the connection between NHS providers and fully integrated healthcare.It is because of this belief that I have welcomed signs that clinical commissioning groups (CCGs) – who in April this year took over budget and commissioning duties for large swaths of the NHS – are keeping in mind the connection between NHS providers and fully integrated healthcare.
Unfortunately though, the government's policies are creating the conditions for a very different landscape, where open tendering and competition now exert a pull away from NHS organisations. As a result, contracts worth billions have already been offered to numerous non-NHS providers. The surge in tenders is one of the first signs that the government's rules on competition are opening up more of the NHS to companies that have not traditionally been involved in delivering care.Unfortunately though, the government's policies are creating the conditions for a very different landscape, where open tendering and competition now exert a pull away from NHS organisations. As a result, contracts worth billions have already been offered to numerous non-NHS providers. The surge in tenders is one of the first signs that the government's rules on competition are opening up more of the NHS to companies that have not traditionally been involved in delivering care.
As the BMA and I have long stated, this process raises dangers, some of which have already become obvious. Big commercial non-NHS providers can sniff out and then cherry pick the easy, profit-making services such as safe one-off procedures, while an increasingly cash-strapped NHS is left with expensive services from caring for older peopl, to the chronically or mentally ill. There is also a question mark over whether service contracts awarded to non-NHS providers can be properly integrated with the NHS or, crucially, properly monitored to provide a good level of care.As the BMA and I have long stated, this process raises dangers, some of which have already become obvious. Big commercial non-NHS providers can sniff out and then cherry pick the easy, profit-making services such as safe one-off procedures, while an increasingly cash-strapped NHS is left with expensive services from caring for older peopl, to the chronically or mentally ill. There is also a question mark over whether service contracts awarded to non-NHS providers can be properly integrated with the NHS or, crucially, properly monitored to provide a good level of care.
A parliamentary report this year into out-of-hours services in Cornwall provided by a non-NHS company, demonstrated a catalogue of failures across the board that were not properly picked up by regulators. Moreover, the recent collapse of NHS Direct's attempt to provide the crisis ridden NHS 111 services demonstrated that government assurances that all winning bids would be vetted to ensure they are financially viable were less than sound. Local GPs in particular warned that some of these contracts were going to very low bids and were promptly ignored. CCGs must therefore think very carefully about how they run their competition process and who these important contracts are going to. What we cannot have is a chaotic, fragmented NHS.A parliamentary report this year into out-of-hours services in Cornwall provided by a non-NHS company, demonstrated a catalogue of failures across the board that were not properly picked up by regulators. Moreover, the recent collapse of NHS Direct's attempt to provide the crisis ridden NHS 111 services demonstrated that government assurances that all winning bids would be vetted to ensure they are financially viable were less than sound. Local GPs in particular warned that some of these contracts were going to very low bids and were promptly ignored. CCGs must therefore think very carefully about how they run their competition process and who these important contracts are going to. What we cannot have is a chaotic, fragmented NHS.
More widely, ministers would do well to consider more clearly whether their competitive framework should proceed. There is very little evidence to support the idea that competition breeds excellence in healthcare. The competitive tendering system will divert funds away from frontline care. Thanks to the changes that have already taken place, administrative costs have risen to at least 16%, in contrast to the pre-1980 figure of less than 5%.More widely, ministers would do well to consider more clearly whether their competitive framework should proceed. There is very little evidence to support the idea that competition breeds excellence in healthcare. The competitive tendering system will divert funds away from frontline care. Thanks to the changes that have already taken place, administrative costs have risen to at least 16%, in contrast to the pre-1980 figure of less than 5%.
The BMA would like the government to honour the assurances it gave on our recommendation that "commissioners will not be forced to use competition" when making their commissioning decisions, and to explicitly state this principle. The best way forward is co-operation between providers, including local authorities and commissioners, with the ethos being that an NHS working together is better for all.The BMA would like the government to honour the assurances it gave on our recommendation that "commissioners will not be forced to use competition" when making their commissioning decisions, and to explicitly state this principle. The best way forward is co-operation between providers, including local authorities and commissioners, with the ethos being that an NHS working together is better for all.
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