The Health and Social Care Act has had a long, turbulent passage through Parliament. Now it is on the statute book, independent sector NHS providers hope they can get back to sensible partnership working that helps patients.
Over the past 18 months, there have been increasingly polarised debates about the role of the independent sector in the NHS. Completely unfounded talk of privatisation has heavily outweighed a detailed analysis of the improvements that managed competition can bring to the health service and to the patients it serves.
Disappointingly there has been little discussion about what the independent sector can do in practice to support the NHS at a time when the service is faced with colossal savings targets while striving to innovate and improve care.
There has been an emotional and ideological debate about the politics of health, which those opposed to change have maximised to the full. But there has been virtually no discussion about the serious, practical business of healthcare.
There is wide acceptance in the NHS that it will need to change the way it works if it is to respond to growing pressures and still improve the care it provides. The service will need to innovate and reshape itself around the changing lives and individual requirements of patients and local communities.
As we move into implementation of the reforms, we need to restate the key issues and reassess, open mindedly, how all sides can work together to make the system deliver the best possible care.
For the independent sector, three immediate priorities stand out if the reforms are to succeed. The first concerns Monitor’s licensing regime. What the sector and the whole system needs from Monitor is a licensing regime that is proportionate, recognises the differences between diverse types of provider, incentivises innovation, and reduces barriers to new entrants – all in the interests of driving up quality and value.
Monitor has, commendably, been consulting early to try to understand the very different conditions that apply across the range of providers. We need a regulatory model that is not overly based on the “big utilities” and foundation trusts but caters for a more varied, plural health sector. A level regulatory playing field does not mean a “one size fits all” model.
The second matter of urgency for independent providers is to make sure clinical commissioning groups fully understand what the independent sector can contribute to the NHS and put themselves in a better position to take advantage of this as they grapple with the challenges facing them in their local health economies. We know from past experience that even well established primary care trusts were often not aware of alternative forms of provision, whether in terms of providers or pathways, and were often enthused when these were pointed out. So there is a high quality marketing job to be done.
The third priority to address is integration. Competition and integration are not mutually exclusive. Competition to see who could provide the best integrated services is a powerful formula. But we will not reach a stage where the NHS provides genuinely integrated services unless the incentives in the system are changed. We must look at what levers can be used to encourage closer working between providers so patients receive a seamless service tailored to their needs, not a disjointed system they struggle with, often when they are least inclined to do so.
To the demographic, technological and financial challenges, the NHS now must add that of implementing a set of reforms so radical that, in the words of NHS chief executive Sir David Nicholson, they can be “seen from outer space”. In due course this will undoubtedly drive a much more constructive reappraisal of how the independent sector can best contribute, but to get there we need to move beyond the ideology and rhetoric about the role of the private sector and start an honest debate about how the sector can help, whether through competition, partnerships or simply subcontracting.
The commitment to patient choice rings hollow without diversity of providers to make it meaningful.
Commitment to the underlying principles of the NHS rings hollow without minds that are open to new and better ways of delivering on those principles. The task now is to work together to get on with the job of looking after patients – and putting their interests first.