Andy Burnham speech delivers body blow to NHS competition and choice
The government’s commitment to choice and competition is unravelling.
Under world class commissioning, creating effective markets is supposed to be vital to raising quality and promoting efficiency. Primary care trusts have been encouraged to consider “any willing provider”.
PCTs are not even free to turn to another provider when the existing one is delivering a demonstrably poorer service
But last week health secretary Andy Burnham used an otherwise unremarkable speech at the King’s Fund to say the NHS is the “preferred provider” of services.
He went further. PCTs are not even free to turn to another provider when the existing one is delivering a demonstrably poorer service. The DH is to issue guidance on the process that should be followed to give existing providers an opportunity to improve before others get a look-in.
Muddled thinking is evident. The crucial passage in Mr Burnham’s speech begins by saying NHS providers are preferred to those from outside the service, but the subsequent wording on allowing the existing provider to get their act together seems to apply even if the PCT would want to move from one NHS trust to another.
When asked for clarification on the implications of Mr Burnham’s speech, the DH said there had been no change to the world class commissioning regime.
But that claim falls apart when the secretary of state’s words are compared with the 2006 white paper Our Health, Our Care, Our Say, which says a pivotal theme of the commissioning framework is to encourage open tendering as a way of stimulating innovation, quality and choice for patients.
There are similar disparities between the speech and the remit of the co-operation and competition panel - just a few months old - which is charged with ensuring competition between services is fair and transparent.
A fault line has opened up in health policy. Using competition within the NHS and between the NHS and the independent sector was one of the iconic reforms of Tony Blair’s “third way” politics. Ministers need to explain whether giving poor services a second chance is now more important than using competition to drive innovation, quality and choice.
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Readers' comments (6)
Anonymous | 24-Sep-2009 12:29 pm
Government of any political colour has a problem. A private sector senior manager who is paid bonuses solely for 'increasing shareholder value' will not be playing a game. Buying in a cheaper clinical service from a multinational company, last week known only for mending your computer will probably lead to misunderstandings. The PCT owns the pitch but the private provider holds the bat and ball. The PCTs have been known to exaggerate the fineness of their ground and have issued contracts based on (mis)understandings rather than firm and enforceable specifications. Where the company finds that the ground is not as described, and cannot wriggle out of the contract ,’Can't play, won't play’ becomes the order of the day.
It would look even worse for government if the private providers were publicly given the boot for not 'playing the game' so, of course, the DH will want to ‘give existing providers an opportunity to improve before others get a look-in’ - at least until after the next election.
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Anonymous | 24-Sep-2009 1:51 pm
We have come so far in delivering change...yet the SoS wants to turn the boat around now at a time when patients expect more, the economists want efficiency and managers need certainty?
Flaws in current policy exist - let's be clear - but to row-back on choice and competition will not only do a disservice to patients but will also lead to further confusion out on the management frontline.
Managers have been given a set of tools to engineer positive change - choice and competition are amongst these - and the SoS demonstrates his own naivety by suggesting that these tools can be removed simply on a own whim (or perhaps just to flatter the ever-misguided Unions who themselves appear intent on weakening the position of Labour when they will be needing all they help they can get from in 9 months time when the Tories get in).
These are diffciult and dangerous times when clarity and commitment are required, not a SoS out of ideas, pandering to the Unions and trying to undermine the good work of others...
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Anonymous | 28-Sep-2009 11:23 am
Should anyone take any notice of what Andy Burnham has to say? He will be one of a depleted opposition front bench by June 2010.
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Anonymous | 29-Sep-2009 3:27 pm
And where does this leave the tranche of handsomely paid commissioning managers with fearsome sounding job titles? Drinking tea and eating sandwiches with preferred suppliers I suppose.
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Anonymous | 29-Sep-2009 8:07 pm
Dear Old Andy - He's a card and no mistake! Our World Class Commissioners and the Procurement chaps will have their work cut out trying to get dismal service providers up to speed and working hard to decide which service provider to choose out of a list of one!!
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Anonymous | 29-Sep-2009 8:59 pm
Choice is a tool.
Worse it is also a politically and ideologically weighted tool.
Those who wield it apply choice to everything even if it isn't appropriate.
Wouldn't it be better to understand the problem systemically and then design tools that are suited to that problem?
It is a rhetorical flourish. Yes of course it would.
When you listen to what matters to patients that don't say I want to choose between Dr A & Dr B. What matters tends to be help me get better and then perhaps they may say somewhere close to where I live.
Choose is the last chance saloon because those 'in charge' don't know how else to improve the problem.
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