Daily Insight: Keeping a check on choice

The recent NHS reforms to create integrated care systems have been difficult for private providers – which were better served by a more competitive system.

They have been making the case that patient choice is being eroded by collaboration, flagging local examples of commissioners wanting to keep funding within the NHS.

The Independent Patient Choice and Procurement Panel was recently established to oversee cases in which private providers have struggled to gain accreditation to provide services, and its chair Andrew Taylor was asked to carry out a review of the extent to which patient choice is being offered.

His review has now highlighted significant variation in choice between some systems, which it said was driven by factors including messaging from commissioners to GPs that discourages choice and/or encourages referrals to local NHS trusts; financial incentives for referrals to particular providers; and difficulties in securing accreditation from commissioners.

It cited one example where the operator of an independent sector hospital that is co-located with an NHS hospital was contractually prevented by the NHS trust from accepting certain referrals.

Mr Taylor also flagged consistent concerns over the extent to which some referral assessment services may be limiting choice and channelling referrals to particular providers. In some cases, the referral assessment services are operated by NHS trusts, raising concerns about potential conflicts of interest.

To remove the local constraints, Mr Taylor made several recommendations, including that NHSE should “monitor and regularly publish data, by ICB and speciality, on the number of e-referral service appointments made available to patients but not used”.

He said this would provide information for patients and GPs about services where patients may be able to access care more quickly and identify regions where local discussions could be had to better utilise capacity.

In a statement, ministers confirmed the recommendations had been accepted and would be implemented.

Unearthed problem, unpublished report

A report into racism in an integrated care system has been described as “disgraceful” by an ICB board member – as it emerges health leaders received it more than a year ago but failed to discuss it in public.

Shropshire, Telford and Wrekin Integrated Care Board commissioned a report into racism across its main health providers in 2022 and received its findings in November 2022.

However, the report – which saw one non-white staff member recount being told by a colleague “you have come in to take all our jobs” – was not brought to the public board until April 2024, following several requests from a non-executive director for it to be discussed in public.

Key findings, which HSJ has seen, revealed 79 per cent of non-white and 56 per cent of white staff agreed racism between colleagues was a problem.

Telford and Wrekin Council’s chief executive officer David Sidaway, who sits on the ICB, told the recent board meeting: “It’s incumbent on all of us to get an action plan in place… because it’s nothing short of a disgrace.”

ICB CEO Simon Whitehouse rejected suggestions his organisation and providers did not have action plans in place and said they were “absolutely actively working on this”.