• Foundation trusts will only stop acting as “islands in the sea” of integration if “very, very fundamental changes” to financial incentives are introduced, Lord Prior said
  • Integrated care systems will require “some legislative changes” he said during pre-appointment hearing on his NHS England chairmanship
  • Said “gut instinct” is that integrated care contracts should be “wholly NHS” to maintain “trust” in the process
  • Decided not to resign the Conservative whip but would reconsider if the Health Committee asked him to do so

Foundation trusts are “islands in the sea” of integration and will not change until fundamental changes to regulation, legislation and financial incentives are made, Lord Prior has said.

Grilled by the Health and Social Care Committee in a pre-appointment hearing yesterday before his chairmanship of NHS England is confirmed, Lord Prior gave his views on a wide range of issues.

He revealed:

  • He “agonised” over his decision not to resign the Conservative whip for the tenure of his chairmanship but felt it wasn’t “credible” to do so
  • Said the “single biggest, most important role” of NHS England is to implement a “very, very fundamental change” to financial incentives in the NHS
  • Tendering for all contracts is “absurd” and the NHS must “get used to a far greater degree of trust” as contracts will run for 15 years or more in the future
  • His “gut instinct” is that new large scale providers that take on integrated care contracts must be “wholly NHS and be put on a statutory basis as they hold the money”. To not do so would undermine “trust” in the whole process
  • The Five Year Forward View was “very perceptive.. but it was [a] view rather than a plan. Next five years will all be about implementation… [but] there will be some legislative changes required to let integrated care develop”
  • Not all parts of NHS England and NHS Improvement “need to merge” as improvement support “doesn’t sit happily” with the regulatory side.

Lord Prior told the committee, the purchaser/provider split and the regulatory system have “got to be addressed” if foundation trusts are to “become part of the system”.

He said: “NHS organisations are very trained to follow the money. Everything we have done over the last 25 years has been to encourage FTs to look after themselves and not the system, that whole psychology has got to change”.

“Bringing these integrated care systems into place means changing the whole financial architecture system… and it requires a very, very fundamental change to how we have incentives running round the system,” he added.

He said in his role as chair of University College London Hospitals Foundation Trust, “inevitably our team is looking out for UCLH”. He said they would get “no thanks from NHS Improvement or the Care Quality Commission” if investing in care beyond its regulatory responsibility hit core financial and quality responsibilities.

He also said legislative changes were required to “develop” integrated care systems. “There is a limit to what you can do with workarounds before you start to undermine the whole basis of the existing legislation”, he told the committee.

Although the government has said it will listen to requests from NHS England to change health legislation there is no guarantee this will happen or in what time frame.

Chair of the committee, Dr Sarah Wollaston, Conservative MP for Totnes, said the committee had asked Baroness Harding in writing to resign the Tory whip before she became chair of NHS Improvement but she had refused.

Lord Prior said if the committee asked the same of him, he would “definitely take that into account” but he “wouldn’t like to say now how he would respond”.

He added, however, that the committee had a “very strong point and a very strong argument” about resigning the whip and he had ”wrestled with that”. He said he would abstain from voting on health policy but not on issues such as the budget. He said if he couldn’t agree with the government on how he should vote, he would resign.

He added: “I am 63, this is my last job, there is nothing the government could give me that I would want. I am more independent now than I have ever been.”

Lord Prior also revealed he no longer had private health insurance and had used the NHS over the summer as he had been treated for skin cancer on his neck.

He also outlined his thoughts on Brexit and the future of the NHS.

He said he wants to “take an active role” in ensuring NHS has “proper immigration visas” after Brexit to resolve staffing concerns and thinks it is “reasonable” for the NHS to publish its no-deal Brexit contingency plans.

He believes the three biggest issues for the NHS over the next 10 years are “prevention, technology and integration” and he would like the NHS to become known as the ”greatest healthcare test bed in the world” within that timeframe.

He also said NHS England must work closely with Public Health England in the future to resolve major concerns about childhood obesity. 

Lord Prior was previously a health minister under Jeremy Hunt, with responsibility for productivity, from May 2015 to December 2016.

He was chair of the CQC from 2013 to 2015 and is currently chair of University College London Hospitals FT, a post he took up in December.