Fishburn Hedges

09.05.2011

It is an understatement to say that NHS reform is in a state of confusion.

This is certainly not the first time the NHS has been used as a political football - and it’s unlikely to be the last. But following last week’s local election the Health and Social Care Bill has taken on a new significance. It has become a symbol of the Liberal Democrats’ reclamation of their voice within the Coalition.

Among the political wrangling, it’s hard to gauge where the power really lies.

Lansley’s Future Forum, led by Steve Field, is heading up the current ‘listening exercise’. Meanwhile, in what could be seen as a vote of no confidence, the Prime Minister has authorised his health advisor, Paul Bate, to set up his own advisory panel of NHS ‘heavyweights’, as well as ‘planting’ another of his advisors, Sean Worth, in the Department of Health.

Then we have Nick Clegg, backed it would seem by George Osborne, demanding significant changes to the Bill. Plus Clegg’s chief advisor (and Lansley’s arch-enemy) Norman Lamb is becoming an increasingly prominent voice.

So what’s the problem with the proposed reforms?

Putting aside the broader question of whether the Health Bill is, in fact, dead in the water, let’s take a moment to consider where the points of contention lie within the reforms.

1. The GP role. While there is general consensus that clinicians should have a greater role in commissioning, the question is: to what extent?

At a political level there are concerns about giving too much power to GPs and a significant proportion of GPs themselves are reluctant to take on the new responsibilities. There is also a range of other voices to consider, not least frontline staff such as nurses and secondary care clinicians who worry they will be sidelined by GP consortia.

2. Private sector involvement. In addition, conflicting views exist about the role of the private sector. In an early ‘clarification’ from the Department of Health we have already seen ‘any willing provider’ become ‘and qualified provider’ and, putting aside accusations that Lansley is ‘outsourcing’ the NHS to GPs, there is growing concern about how open a market the NHS should really be.

A leaked memo from Francis Maude’s office recently revealed real anxiety about a return to ‘wholesale’ outsourcing of NHS services, and just this morning the RCGP expressed its view that opportunities for private and voluntary sector bodies to bid for NHS contracts should be limited.

3. Change for the sake of change? We are talking about a complete restructuring of the health service. There are clear concerns that in making changes the baby should not be thrown out with the bathwater, and that previous investment in developing commissioning skills within PCTs should not be wasted.

4. The money question. Finally, and most significantly, all this is underpinned by a real and pressing need to make major efficiency savings in the NHS. As yet there is no clear sense that the reforms on the table will be able to deliver these savings.

What does all this mean for private sector providers?

Clearly the biggest challenge - for those inside and outside the NHS - is determining where the chips are likely to fall. The debate is becoming increasingly entrenched, and at a political level has taken on a significance beyond what it actually means for the health service.

The argument about the role for private providers is a particularly difficult one, as it is as much – if not more - about the broader Tory rhetoric of privatisation, and all that this implies, as the reality of its impact on the running of the NHS. 

At least until the Future Forum reports back next month, it will be hard to tell where the most significant buying power will sit. As a private sector provider selling services to the NHS, should the focus be on pathfinder GP consortia, the 52 PCT clusters, the National Commissioning Board, Local Government, or all of the above?

The answer to this question could mean private providers have to significantly reassess their business models.

Right now it is very hard for the private sector to get its voice heard among all the other players in the debate. However there is a more pressing concern.

Amid the uncertainty, PCTs are beginning to down tools and decommission many services delivered by the private sector - enhanced pharmacy services for example. There is a potentially dangerous gap emerging at the local level while the Bill is being kicked around in Parliament. 

So what do we actually know?

Putting aside the uncertainties, it’s possibly more helpful to look at what we are sure of at this stage.

We know that cost efficiencies and a better patient experience are at the heart of the reforms. Any provider - private, voluntary or public sector - needs to be able to demonstrate an ability to support these aims.

We also know that whatever form the commissioning structure eventually takes, it is a fairly safe bet that GPs in particular, and clinicians more widely, will have a greater role in decision making. Similarly, local councils will almost certainly have an expanded role in public health and as health and social care provision are brought closer together. 

We know that many of the senior commissioners in PCTs will still be around when the reforms come into place, whether on the boards of GP consortia or elsewhere. We also know that there are a number of significant players emerging who will no doubt continue to influence at local and national level over the coming year.

At a national level Stephen Dorrell and Norman Lamb are clearly ones to watch, particularly if you go in for rumours of likely successors to Lansley. At local and regional level the individuals worth getting to know include the PCT cluster chairs such as Mike Burrows in Greater Manchester and the heads of the ‘leading light’ GP consortia such as Darin Seiger at Nene Commissioning or Shane Gordon at North East Essex.

Finally we know that there has always been and will continue to be a significant role for the private sector in delivering health and care services on behalf of the NHS. In particular in supporting more efficient service delivery, based on a strong understanding of local need and desired health outcomes.

What should companies be doing now?

So what does all this mean for private sector providers looking to influence the new NHS landscape?

Firstly, it’s clear that all providers need to think local. In building a case to government and to commissioners alike, the focus must be on proven local impact.

Seeking access to the key national and local influencers will be key over the next few weeks, to gather information and help inform a clear offer and ask: setting out exactly how they can support the Government’s aims for the NHS and what they need from the reforms in order to be able to do this.

These conversations should also inform a response to the Future Forum report due out in early June, as well as a submission to the House of Lords at the next phase in the progression of the Health Bill – if and when it gets there…

Posted by Ayesha Bharmal