UK Health reforms under scrutiny; we ask the big ‘procurement’ questions

We try not to take a political stance here; comments on Government policies are restricted to their procurement aspects and are judged on a pragmatic sense of 'will it work' rather than anything ideological.

So our occasional posts on the health reforms are not motivated by any sense of 'saving the NHS' or indeed 'let's privatise the NHS'. Rather, the questions we've raised going right back to last summer have been based on "will the commercial / procurement elements of this work"?

And with the reforms in the news again, and apparently being reviewed at least, it's worth just asking our key questions again around those commercial mechanisms.

- How will the idea of  'any willing provider ' work - how can providers (public or provider) have any volume certainty under that arrangement, and how can GP Commissioners contract and budget on that basis?

- How will we avoid providers 'cherry picking' elements of the work, leaving traditional providers with the stuff no-one else wants to do?

- Are we clear how EU procurement regulations apply? And how will price / quality be assessed and evaluated in the competitive process? (Although now it seems that price may not be part of the the equation at all, in which case the question may be 'so how will this contribute at all to greater efficiency'?)

- How will we avoid conflicts of interest e.g. where GPs want to be the provider (as well as the purchaser)?

- What happens if a GP group runs out of money - who holds contractual liability and how would  services be maintained in that situation?

- Do GPs have the capability (procurement, finance etc) to deliver this commercial activity?

- How can 500 'procuring bodies' be more efficient and lower cost than 150 (the current PCT count)?

I think one of the main concerns about the reforms has been the lack of clarity on detailed points, often commercial in nature, like these. In some cases, the policy seems to be very fluid - for example, whether there will be price competition or not.  In other areas of Government policy, you get the impression that, whether you personally agree with it or not, someone does know how they want things to work. That sense of direction hasn't perhaps been quite as well communicated in Health.

And if the competitive elements of the original proposal are watered down, as now seems likely, we may be left with changes that are still expensive and disruptive, but don't actually drive any increased efficiency in the system - which could end up being the worst of all possible outcomes.

Makes you glad you're not the Health Secretary!

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