Manifesto: Tories open to legislation to curb internal market

It also commits to “review the operation of the internal market and, in time for the start of the 2018 financial year, we will make non-legislative changes to remove barriers to the integration of care”.

Health secretary Jeremy Hunt told HSJ that the “internal market is too bureaucratic”, and indicated that changes could a shift to capitation funding, under which providers receive budgets for the care of their entire population, eliminating some commissioner functions.

The manifesto states: “We will hold NHS England’s leaders to account for delivering their plan to improve patient care.

“If the current legislative landscape is either slowing implementation or preventing clear national or local accountability, we will consult and make the necessary legislative changes.

“This includes the NHS’s own internal market, which can fail to act in the interests of patients and creates costly bureaucracy.”

Over the past year senior NHS figures, including NHS England chief executive Simon Stevens, have indicated that parts of current NHS legislation, including the Health Act 2012, can make it more difficult to develop integrated care and new contracting and organisational models.

Potential options for legal change range from changing competition and/or procurement law; merging NHS England and NHS Improvement, and potentially other quangos; to creating new NHS structures locally or regionally – potentially eliminating or dramatically reforming the commissioner/provider split.

The NHS has begun work on developing accountable care structures, but is at a relatively early stage. Many of those involved see it as very difficult within current legislation and rules.

NHS England is currently working to prepare to announce next steps for the NHS’s first “accountable care systems” shortly after the general election, with up to nine areas of the country. However, many important aspects of how these will work and be structured are very unclear.