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For the first time in almost a decade, the health and social care sector is facing legislative change
After years of policy inertia, limited to ‘forward views’ and ‘long-term plans’, the government has decided a global pandemic and the rollout of the most ambitious vaccination programme in the health service’s history provided the perfect conditions for complex structural reform.
The White Paper – formally titled ‘Integration and Innovation: working together to improve health and social care for all’ – outlines an ambitious set of plans to allow multiple providers in local areas to work together more closely, removing many of the competition-driven structures devised by the fatally complex (and compromised) Health and Social Care Act 2012.
At one level, clearly this makes a great deal of sense. The network of provider organisations that we call the NHS has always been a patchwork quilt, rather than a cohesive body. The idiosyncrasies of the system and the regulations that govern it creates a constant stream of work for the legal professionals in the sector but can be maddening for those trying to operate within it.
Where this quest for simpler, better integrated systems leaves the independent sector is another question. A central tenet of the Lansley reforms was the belief that allowing providers within the system to compete against each other to deliver services would drive up quality while reducing costs. This theory of markets obviously has some merits – but for competition to thrive, a level playing field is required. In the NHS, creating these conditions typically requires a bulldozer and the pain and the politics of the procurement often outweighs the upside of any innovation.
When steps forward are made – as they undoubtedly have been – the nature of the health service’s funding can also be a barrier to sustainable partnerships. The health service may be happy for a provider to profit from innovation – but when the time comes to re-procure its mindset is not inclined to leave a healthy profit margin on the table.
The White Paper pledges to remove the current legal requirement to competitively tender for healthcare services – and this has been interpreted by some media outlets as the death knell for independent sector involvement in the NHS. History suggests that the reality will be more complex and unpredictable.
Through a political lens, the rowing back of private sector involvement could be seen as an expedient measure – not least for a government and a health secretary under scrutiny for their awarding of contracts throughout the Covid crisis. But the other eye-catching measure in the White Paper is the extent to which it returns control from NHS England back to the health secretary. Positioned as a means of making healthcare more politically accountable, this could also have long-term implications for the private sector.
As we emerge from the Covid crisis, healthcare will be central to the thoughts of government and public alike. Addressing the backlog, dealing with new variants and preparing for a future in which the coronavirus is a constant threat will all require significant investment in the healthcare system – a system whose limitations have been fully exposed by Covid-19. And just as the independent sector grew significantly under New Labour, as it provided excess capacity to bring down waiting times, private sector providers will surely have a significant role to play as we all adjust to a transformed world.