New Options for the NHS, but will Competition Law Intervene?

The UK's National Health Service (NHS) is facing probably its greatest challenge ever. The finances of the system are at breaking point, achievement of targets is on the decline, a third of major hospitals don't have a permanent Chief Executive in post, the use of expensive agency staff is going up and up ... the issues seem never-ending.

So the speech last Friday at a CBI conference from Simon Stevens, the NHS England supremo, announcing a new approach - well, a set of “new options for the future of local hospitals across the NHS” - pioneered by a small number of "Vanguard" trusts, was critical.

There is a lot of detail to be considered, but the strongest overall message seems to be that we will move to a much more planned economy in health provision, with groups of hospitals formed under the leadership of the best, planning at local and regional level to get more joined up approaches, and specialist trusts taking on a wider role. In fact, here are the full descriptions via this link or in summary here to save you going and looking them up:

A) Excellently-performing individual NHS hospitals able to form NHS Foundation Groups to raise standards across a chain of hospitals (a model of hospital ‘chains’ frequently used in other countries).

B) Individual clinical services at local District General Hospitals being run on site by specialists from regional centres of excellence (for example, orthopaedics, ophthalmology, and neurosciences). Also in this model, a smaller trust draws in expertise from larger and surrounding trusts through a mixture of both networking and franchises.

C) Forming ‘accountable clinical networks’ integrating care across District General Hospitals and teaching hospitals for key services, including cancer and mental health. As recommended by the recent independent Cancer Taskforce, the new cancer vanguards will work towards taking accountability for a population budget for cancer care, able to operate across sites, move investment into speedier early diagnosis, and optimising combinations of cancer surgery, radiotherapy and chemotherapy.

Now that may all be very sensible; we're not expert enough in the complex wider health issues to comment really on what this will do to the overall system finances or health outcomes. But what is puzzling is how this can sit alongside the Health and Social Care Act (2012), which introduced a whole system of competition, clinical commissioning groups (CCGs), independent Trusts and indeed private sector firms competing to win contracts, and so on. The new approach seems to ride straight through the middle of this legislation - but there is no mention of repealing it, or how the new ideas can sit alongside or within that existing legal framework.

Is Stevens just hoping that no-one will complain and the new ways of doing things becomes the norm? Are politicians afraid of doing anything about the law because it would show what a huge cock-up Andrew Lansley made of the system back in 2010-12 (and the Prime Minister and Chancellor didn’t stop him)? Will public sector bodies be persuaded not to challenge because at the end of the day, they are publicly funded, so don't want to rock the boat?

But surely it only needs one private provider or indeed foundation Trust (all with independent Boards of course) to challenge and say, "we would have liked to compete for that work, and it has just been given to a Vanguard Group, or Moorfields Eye Hospital, without any competitive process" - and there will be a real issue.

How exactly is this new process going to work - are we missing something here? More than willing for someone to explain if we are, but in the meantime, we will just remain puzzled and confused. And what on earth does this mean for the huge Commissioning “industry” of CCGs, external consultants, CSUs and so on in the system?

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