My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

Read my statement in full »

The White Paper – Liberating the NHS and the independent sector

Filed Under (Creating public value, Health Policy, NHS Providers, Reform of the NHS, Third Sector, White Paper) by Paul on 23-07-2010

If there is one group that should have received the White Paper with unalloyed pleasure it is the private sector health care companies who are trying to sell their services into the NHS.

One might expect that a new Conservative Government, after 13 years of Labour and a reforming market-based programme for the NHS, publishing this White Paper – within 10 weeks of coming to power – would give them huge market opportunity and guarantee their support for the White Paper.

So it was with some interest that I went to speak to NHS Partners – the private sector section of the NHS Confederation. This fact that this talk and discussion had been scheduled to come the morning after the publication of the White Paper on July 13th made it very interesting.

So after getting up at 05 30am to complete my PowerPoint presentation I went off to a very interesting discussion.

My personal background position on the involvement of the private sector in the NHS is clear. I believe that NHS patients get a better service if they have as wide a choice as possible of who is delivering those services. I also believe that competition between NHS organisations and between NHS organisations and the private or the third sector will lead to a faster spread of innovation in the NHS.   

In October 2009 I wrote an article in the HSJ attacking the then Secretary of State for trying to impose his personal preference for NHS-run services on the whole of the NHS. Between then and March readers of this blog followed the saga of the Secretary of State being taken to his own Panel on competition for trying to enforce anti-competitive behaviour.

So I not only have a position on this but also some track record of trying to generate increased competition with and within the NHS.

A White Paper that creates a ‘level playing field’ between the different sectors – private, public and third sector – is one that I welcome and I would have thought the private sector would too.

But the audience of private sector organisations on 13th July were far from happy – for two main reasons.

Firstly the immediate next two years. The private sector tries to develop and sell health care services to the NHS all the time. To do this they establish relationships with the people who are buying those services and come to understand the needs of their clients as closely as they can. At the moment PCTs are their clients and they have been coming to terms with what PCTs want to buy for some time.

They recognise that out of the 150 PCTs there were some that were open to new markets and some that were closed. But over time discussion and opportunity were moving more into the first group and more deals were being made. Now the Government are proposing to completely scrap the very people who make a market and to replace them with buyers of services who do not exist. As far as most of the private sector is concerned this closes the market down for the next two years.

The private sector consists of real organisations that need to do deals to stay alive. The top down reorganisation of their market for two whole years (at least) will undermine those deals and will lead to less private sector work in the NHS during that period.

Their second problem was with the overall philosophy of the White Paper. As I have commented the stance of the Government in the White Paper is outlined in the phrase “liberating the NHS”. The Government believes that its role is to get out of the way and that this very move will lead to a growth from the entrepreneurs and activity below. All the Government has to do is remove itself.

Last week most people who commented felt this was naïve in the extreme. Most of the markets that they worked within had come about because of direct central Government intervention and not through too much of it.  

In terms of political philosophy, the Government believe that laissez faire – leaving the market alone is doing enough. The people who work in the market believe that this market actually needs to be made in an active way by the Government.

In terms of the history of markets the private sector is correct. The state has to actively create a market – they do not emerge of their own accord. What the private sector recognised in the current NHS was that most commissioners had a cultural allegiance to the NHS which meant that they would not, simply from within their culture, create a market. They do not welcome new entries into this market and look upon new entrants as opportunity. Most buying of health care is based on last year’s contract plus or minus 3%.

This is not a market. For the next few years the private sector recognise that we are in a phase where that market has to be made and  Government that simply steps back will hinder the making of that market – not help it

There was some recognition that GPs, being small business people, might make better commissioners in terms of markets, but also much disappointment that they were to be forced as commissioners into statutory organisations.

Incidentally an issue of detail in the White Paper came up in paragraph 4.27. At the moment this says “In addition we will develop Monitor into an economic regulator from April 2012, with responsibility for all providers of NHS care from April 2013”

If this phrase were to mean responsibility for NHS providers of care it is one thin since it refers to Monitor’s extended role in performance managing all NHS trusts who have not become FTs. But the way it is drafted at the moment means that an organisation which is primarily a private sector organisation will become the “responsibility” of Monitor the moment it provides any NHS care. This would be odd.

I will return to this issue often.

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