No one in healthcare doubts that the public debt crisis has initiated a period of radical change across the NHS. The essential challenge is to become more efficient and flexible.
Could the growing role of healthcare charities offer a market solution? Might NHS providers become more like charities? The new government, seeing the voluntary sector as a model of social enterprise, appears to have this in mind.
Healthcare charities have a mainstream role in many different countries. In the US hospital groups like the Mayo Foundation have a reputation for excellence and have grown into multibillion dollar organisations well placed for the changes planned by the Obama administration. In the UK most charitable hospitals were swept up into the NHS in 1948. But the growing role of voluntary sector models is worth examining in comparison with foundation trusts.
Charities in UK healthcare provision have similar values to the NHS, and a good reputation in the public eye. Their record of service innovation is strong, especially in personalised and community based care. Some are well known and substantial providers, such as Macmillan and Sue Ryder.
Nuffield Health is a charitable provider bigger than most foundation trusts. Innovative and competitive, it is well ahead in preventive healthcare, linking gyms and check-ups with diagnostic and hospital services. It provides a substantial volume of elective surgery through choose and book, allowing NHS patients a free choice of voluntary sector healthcare.
Less visible is an even bigger area of public outsourcing, running into billions of pounds yearly, for community, residential, specialist and secure mental healthcare. This has been pioneered by the voluntary sector and provides choice for patients and commissioners in almost every locality. Some are best known for campaigning on mental health, for example Mind. St Andrew’s, the charity I work for, has for decades led innovation in secure care.
Charities excel at open team working, and the St Andrew’s research and service development involves the National Autistic Society, Headway, Age Concern, the Huntington’s Disease Association, Sign Health as well as King’s College London. Our awarding winning hospitals have a strong reputation with NHS commissioners, cost less to build than NHS units and compete successfully with both public and private sector facilities.
There is something special about many charities which helps us both complement and challenge NHS provision. Inspired by our not for profit values, and empowered to take decisions, our flexible and dedicated workforce makes us both innovative and cost effective. This trend should be accelerated in an open public healthcare market.
Unfortunately an open and contestable market has not yet materialised. The NHS is still largely the preferred provider. This bias is ingrained in commissioning practice, which typically takes too much responsibility for the stability of local NHS trusts. Charitable providers have learned to thrive in a world of spot purchasing and short term contracts. The new government needs to set a stretching 10 per cent target for NHS spend in the voluntary sector by 2015, and ensure that abrupt withdrawal of contracts is not disproportionate compared with NHS providers.
Now let’s look afresh at foundation trusts. Many are descended from pre-1948 charitable hospitals and most have a strong local identity. “Foundation”, “trust” and “board of governors” sound like features of a not for profit social enterprise. They are trying to become more autonomous and agile, as charities have done.
Surely foundation trusts and charities should be equal players on a genuine “level playing field”, learning from each other. Both should welcome real competition, as commissioners and regulators drive out costly, ineffective practice.
Charities will need to provide much more for the NHS. They will learn from and challenge foundation trusts to become more independent and dynamic. Now is the right time for healthcare leaders to welcome such competition and make it happen.