RE: The private sector will not, as some reports suggest, face banishment from the health service.8 Feb 2021 07:54
The result has been billions of pounds wasted in the administration of pointless processes, clinical staff caught up in the complexities of procurement and competition rules, and a quangocracy unable to coordinate or collaborate and left unaccountable to the public or politicians.
Now, it seems, the Government has learnt its lesson and decided to upend at least two decades of market-based health reforms. Matt Han****, the Health Secretary, plans to give ministers the legal powers to direct the NHS. Market mechanisms are out and collaboration is in. Regional structures will go, and more local units, based on counties, will come in. A “triple aim”, of better health and wellbeing, better care, and the “sustainable use” of NHS resources will drive decision-making.
This profound shift has been years in the making, but it was hastened by Covid-19. Successive health secretaries have been outraged that they were barred by law from making decisions about the allocation of resources, which after all reflect judgments about public money and social needs. And they grew equally concerned that the independence of the NHS – enshrined in law by the Lansley reforms – meant that its chief executive was responsible for everything and therefore accountable for nothing.
And over the past year, as the NHS has confronted the pandemic, the flaws of the Lansley reforms became clearer. The silos it created – between different NHS trusts and between primary and secondary care providers – got in the way of the urgent task at hand. “The things that have gone well with Covid,” says a senior government figure, “did so because we managed to get the right people together to solve our problems. But the existing architecture generally prevents that.”
The private sector will not, as some reports suggest, face banishment from the health service. In the name of “payment by activity”, the Lansley reforms mandated uniform price tariffs from private and public sector providers alike. But the white paper rejects this approach on two grounds: first, it rejects the possibility that you can put a single uniform price on treating a patient with a particular condition, and secondly, it believes it can undermine collaboration. This removal of fixed price tariffs might see more private provision if companies can offer better prices.
Nor does the white paper represent a complete abandonment of the reforms initiated by Ken Clarke in the early Nineties. The split between commissioners and providers, for example, will remain. “This is not about a drift to the Left,” a Department of Health insider insists, “but a shift to the local.” And this is in many ways the purpose of the proposed reforms. Han**** is reserving strategic national powers, but by reorganising the NHS into “integrated care systems”, and by legislating to create a new duty to collaborate across the health service and local authorities, he hopes to create a culture of local cooperation among different agencies to impro
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