Time to end the NHS experiment with the market?

It is only five years since Andrew Lansley forced through the biggest change in the NHS in a generation. “So big it can be seen from space” declared David Nicholson – its CEO at the time. Competition, patient choice and GP-led commissioning were all central themes. This was stepping up the NHS market experiment which was first started by legislation in 1989.

The current CEO of the NHS, Simon Stevens has set a new direction, initially laid out in his Five Year Forward View and now being implemented across the country in the form of new models of care. He has declared that the current market structure in the NHS – which gives separate roles to purchasers and providers is on the way out, to be replaced by integration and joint planning.

Ending the era of NHS organisations competing for contracts to treat patients is welcome, but promoting new roles, on its own, closes no doors on commercial involvement in the NHS. New legislation is needed and that been postponed as part of the political fallout of the election result. The existing competition framework and tendering rules therefore still apply. Companies are continuing to win new NHS contracts and there are signs of investment shifting towards the new opportunities being created in community based care.

In this report we explore the evidence about which NHS contracts are being tendered, who is winning them and how these trends form part of the new direction the NHS is now taking. Our data is based largely on a process of analysing published awards, a data base that we have compiled from observations over the last 4 years.

We also review the catalogue of problems that have emerged in the various types of outsourcing that have been tried, as part of the NHS market experiment. Some of these failures have undoubtedly influenced the current changes in strategic approach and led to the widely supported view that this experiment should end.

It is time to act on the knowledge that has been built up about how outsourcing in the NHS can negatively impact upon patients, staff, the level of resources and other NHS services. This evidence makes a compelling case and we would therefore urge the government to repeal its competition legislation and focus on building an adequate level of publicly-provided NHS services.    Full Report here…..

 

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