People are more comfortable with NHS care being delivered by the independent sector than politicians would have you believe, says Howard Freeman
February’s polling for HSJ reaffirmed a long established truth: that people are comfortable with NHS care being delivered by the independent sector. This has been backed up by analysis from the Health Foundation of the British Social Attitudes survey.
‘The independent sector has been making a significant and accepted contribution to the NHS’
Despite public attitudes towards non-NHS providers and the mixed market that has operated since the 1990s, the past five years of health policy (and politics) have been characterised by a debate over the independent sector’s role in the NHS.
With an election coming, these debates show no signs of abating. In fact they are likely to be exacerbated as politicians from all sides look to win the public’s trust on the number one issue of the campaign.
However, as a former chair of a clinical commissioning group I know that the public view of the independent sector’s involvement is closer to reality than the political debate may suggest.
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Rhetoric does not match the reality
For more than a decade the independent sector has been making a significant and accepted contribution to the NHS in many areas of the country, working in partnership with commissioners and other NHS providers.
These partnerships come in all shapes and sizes, and reflect the needs of patients and their local health economies.
Independent sector providers are being commissioned to deliver a range of services across the care pathway, from carrying out diagnostics and acute elective procedures through to improving community care and sexual health provision.
As a result, patients are able to access a choice of providers that can deliver care rapidly.
Effective partnership between providers is also helping to redesign services and reduce pressures on the acute sector.
In the West Midlands, for example, Good Hope Hospital has agreed to work with Healthcare at Home to offer patients treatment at home when clinically appropriate. In two years, this has helped to free up more than 10,000 bed nights and release £1.2m of savings.
When these models work well the legislation should be irrelevant, because it should be about different parties working together towards a common goal: better care for patients.
What do commissioners want?
Commissioners recognise that care is improved through productive relationships with providers, not confrontation. As a clinical commissioner in Merton, I valued strong constructive relationships with all providers irrespective of their ownership.
‘Patients care about outcomes and quality, not process and rules’
What I expected of providers was the same too: high quality care; good value; an ability to adapt and respond to changing requirements; and a willingness to work well with other providers across the health economy. These expectations did not change, even if providers ability to deliver them might have.
For their part, all providers wanted the same thing: stability; longer term planning; working with commissioners, not against them; and fair payment.
The NHS Five Year Forward View rightly focused on the sort of service that patients want – not the mechanisms for getting there. Patients care about outcomes and quality, not process and rules.
Developing new models of care and embedding innovation are going to be challenges that face all healthcare providers over the coming years, irrespective of their ownership status.
But what the independent sector can offer commissioners is something important: the ability to rapidly invest in new models of care.
In return, commissioners and politicians need to recognise that all providers will be looking for some stability if they are to help deliver the ambitions laid out by Simon Stevens and his colleagues.
Looking to the future
Productive relationships based on the mutual goals of investment and stability can deliver for patients.
Since I have begun as clinical director of the NHS Partners Network I have been struck by the independent sector’s commitment to invest and work alongside NHS partners, rather than in competition with them.
‘Most commissioners simply want to work with rather than against providers to deliver the best possible care to patients’
I also know that most commissioners simply want to work with rather than against providers to deliver the best possible care to patients.
Whatever the outcome of the election, this platform makes me optimistic that the NHS and the independent sector can work together to deliver the aspirations of the forward view in the interest of patients.
Dr Howard Freeman is clinical director of the NHS Partners Network and outgoing Chair of NHS Merton CCG