Healthy scepticism? Procurement implications of the NHS strategy re-boot

We’ve been going on about the commercial implications of the proposed health service changes since well before the Prime Minister realised that there were some issues with the original proposals.  So how do the changes announced last week look in terms of some of those procurement related areas that we felt were questionable or worrying?

I do know that there have been some very smart people working on this over the last couple of months, and some issues have been addressed, at least partially. In other areas, the picture is still far from clear.

We were concerned about GPs and conflicts of interest - involving others in the commissioning process may help alleviate that concern. But hospital doctors have come into that picture. Having them involved in consortia decision making brings new issues, when it may be their hospitals who are competing for work awarded by the consortia.

Consortia will have to be more transparent in their activities, which seems a good move. On the other hand, bureaucracy seems to have expanded dramatically with 'clinical senates' and 'health and wellbeing borads' keeping an eye on consortia. And while it is probably good that the introduction of consortia isn't going to be rushed, the NHS Commissioning Board who will act where consortia are not in place could end up a huge and powerful national "procurement quango" - not in line with the whole intent of the changes.

Here’s the Public Service website:

Dr Nigel Watson, chair of the GPC commissioning and service development subcommittee, said: "What we don't want is a clinical talking shop with no decision-making....  the consortia can only be accountable to the commissioning board, they can't then be accountable to the senate and to everybody else. We want to make sure we don't risk the senate just being set up as another layer of bureaucracy."

The focus on co-operation as well as competition may help in terms of some concerns around ‘cherry picking’ of profitable business by private firms. On the other hand, how in practical terms will the balance between competition and co-operation be struck? Who decides whether a service should be put out to competition? And how do EU regulations play into this – can a consortium just decide not to compete something for reasons of "co-operation"? And it could become a convenient reason for inaction and preservation of a not very effective status quo in some areas.

The ‘any willing provider’ also seems to have been watered down, but it’s not clear whether the principle survives. We’ll have to wait and see the bill when it comes back out of committee.

We felt that the original proposals had a high chance of ending in disaster. Our best guess now is that the changes avoid some of the most obvious sources of such disaster; but they increase the likelihood of a long, slow process of increasing pain, with the service either requiring more cash, or increases in waiting times, more stories of drug rationing etc.

So I can see a battle at the next election with the Tories blaming the Lib Dems – “it would all have been better if you hadn’t made up change the plans”, and the Lib Dems saying “it would have been worse if we hadn’t intervened. And Labour laughing all the way to the ballot box, with their “you can trust us with the NHS“ slogans...

I don't know, but I'd put good money on Labour's election slogan in 2015 being "Vote Labour to save the NHS". this will continue to be a huge social and political issue.

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