The IPPR's Joe Farrington-Douglas says private companies may be able to give valuable support to commissioners - but decisions about who gets what healthcare must remain public and accountable
'Revealed:£64bn NHS privatisation plan!; 'Stealth plans to privatise NHS care!'
NHS managers woke up at the end of last month to some shocking headlines. It is not often that NHS commissioning makes the front pages. The offending advertisement in the Official Journal of the European Union, which invited private companies to bid to run primary care trust management services, was withdrawn by the Department of Health.
The charge of privatisation was rebutted. But the episode should start a debate about the future of commissioning. It needs to improve dramatically, and the government is right to be thinking about how to achieve this.
Private companies could indeed support commissioners to improve outcomes and reduce inequalities. But the core functions of PCTs are inherently political and involve hard decisions about who gets what healthcare. These decisions cannot be contracted out. The first priority must be to make commissioning more open, transparent and democratically accountable.
The Institute for Public Policy Research has always been pragmatic about public-private partnerships. We have argued that if your objectives are to improve outcomes, reduce inequality and empower communities you should not place limits on private involvement.
But commissioning does not adequately meet these progressive objectives. Few PCTs effectively measure health needs now, let alone use modelling techniques to predict future patterns. Commissioners often fail to ensure that services meet the complex needs of disadvantaged groups. The public and patients too rarely help shape their own service pathways.
Too often providers have controlled what services are available in an area while commissioners have been distracted by re-organisations. With a market in provision we need intelligent, strong commissioning to drive improvement.
The private sector could help fill some of the gaps. For example, PCTs could buy in data analysis, actuarial services and market research. Not all of this need take place in existing organisational silos, or undertaken by PCTs directly.
The Department of Health is proposing to contract out some aspects of commissioning to generate some competitive pressure on PCTs to incentivise better performance. However, the act of commissioning itself - making decisions on future services - is a line in the sand which the private sector must not be allowed to cross.
Commissioning needs to be public because it needs to be accountable. Many of the core roles of commissioning involve allocating public money and making controversial decisions about entitlement. Commissioning should be a long-term engagement with local people, not a short-term, technically specified contract.
The objectives for commissioning should prioritise outcomes and inequalities. To achieve this, the private sector can bring valuable skills and capacity to the table, as can developing the NHS commissioning workforce.
The new commissioning framework should also ensure that PCTs and commissioning practices are more publicly accountable - but downwards to their communities rather than upwards to Whitehall. Stronger commissioning that focuses on outcomes, inequalities and empowerment could then make headlines for the right reasons.
Joe Farrington-Douglas is a research fellow at the Institute for Public Policy Research which will be publishing a report on health commissioning later this summer. www.ippr.org