NHS Commissioning – more problems brewing around competition law

A number of recent reports have brought the whole area of health service commissioning back into view.  Coincidentally, I’m speaking this week at the Health Care Supply Association conference in Manchester (maybe see you there) – although that event is more focused on hospital based procurement, rather than the commissioning of services from care providers (including hospitals).  Whilst the whole sector is clearly linked, the two types of procurement are somewhat different  - although both need to be done well if taxpayers and patients are to get good value and service from the system.

So, there was a good article on commissioning issues and contract law from Sarah Neville in the FT here the other day, (behind the paywall, but you can register and get a few free article views a month), covering the appearance of  David Nicholson, eminence gris of the NHS, at the Health Select Committee.

The NHS is becoming “bogged down in a morass of competition law” which is leading to higher costs and making it harder to reorganise services in the interests of patients, its chief executive said yesterday. Giving evidence to the health select committee, Sir David Nicholson suggested that the law governing competition in the health service might have to be changed “to enable us to get out of this problem”.

The suggestion is that Trusts and patient groups are using competition law, or the threat of it, to stop decisions that might actually bring overall benefit to the system and patients.

In one instance... competition law had been invoked by a trust to allow it to continue to provide cancer surgery, even though it did not meet the guidelines for providing the service – a situation described as “a scandal” by Stephen Dorrell, the committee’s Conservative chairman.

This is a running sore really, going back to the first discussions of the Lansley reforms. The problem is how to get the “right” level of competition into the system. The reformers wanted to increase the access of innovative private providers into the system, encourage “patient choice” and get some competition between public sector providers.

Decent objectives  - but it seems that you can’t have “just the right amount” of competition regulation. It’s a bit all or nothing.  So now we just seem to have got everyone confused  as to when they must compete, and when these esoteric issues of choice actually stop sensible strategic decisions on helath service provision being made.

Nicholson told the Committee that new legislation might be needed, but of course that takes time and can often have unintended consequences. Meanwhile, issues of conflict of interest between commissioners and providers, (which have worried us for some time), such as GPs providing other services, are still bubbling away beneath the surface, and at some point will I’m sure erupt.

Meanwhile, there are also interesting developments around the Commercial Support Units, set up to support the local Clinical Commissioning Groups... more on that tomorrow.


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