Removal of procurement rules risk ‘turning back the clock’ on NHS reform

The Independent Healthcare Providers Network (IHPN) has warned that amendments to primary legislation designed to encourage collaboration in the NHS could turn back the clock on NHS reform.

Responding to the consultation on implementing the NHS Long Term Plan published by NHS England and NHS Improvement last week, IHPN CEO David Hare said proposals to revoke section 75 of the Health and Social Care Act 2012 and remove the NHS from the scope of the Public Contracts Regulations risked ‘recreating the huge NHS monopolies of old, accountable to managers and politicians rather than patients and the public’.

The NHS Long Term Plan has pledged to reform current NHS commissioning and procurement processes in a bid to remove barriers to integration. The consultation said current procurement legislation can lead to protracted processes and wasteful legal and administration costs in ‘cases where there is a strong rationale for services to be provided by NHS organisations’. Although it acknowledged a continued place for competitive procurement to bring in new capacity and innovative service models, the document said it should be at the discretion of commissioners, subject to a best value test, to decide when to seek interest from other potential healthcare providers.

However, Hare said the plans could lead to incumbency trumping quality.

‘The proposals also risk creating substantial new conflicts of interest in NHS decision making, with a blurring of the lines between commissioners and providers,’ he said. ‘This means that a ‘best value’ test in procurement might simply be meaningless – with NHS organisations directly incentivised to award contracts to each other without due process and no transparency over quality.’

On top of this, he warned the plans could reflect a major new top-down reorganisation of the NHS at a time of significant workforce pressure and deteriorating performance against key targets.

The NHS Confederation welcomed ‘the broad thrust of the proposals’, which it said should remove some of the barriers to effective collaboration in the health service.

However, NHS Confederation CEO Niall Dickson said the proposals also needed to ensure that local systems can offer choice for patients and that clear mechanisms are in place to hold individuals and systems to accounts and avoid creating conflict of interest.

Hare said proposals around strengthening patient choice were encouraging, but added: ‘Having embarked on this engagement exercise, it is important that any final proposals for legislative change do not turn the clock back a generation and reintroduce outdated NHS planning and delivery structures. Instead, the NHS must build on two decades of work to create a more patient centred, responsive and plural NHS.’

The consultation exercise will run until 25 April 2019.