Ending the NHS market in England

This week the Health and Care Bill is being debated in the House of Lords. The CSP along with our colleagues in the Community Rehab Alliance and health unions are lobbying peers to support changes. But the CSP is supporting the Bill in principle as the right thing for healthcare and for our members.

by Rob Yeldham

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The internal NHS market will be scrapped under a new bill

Back in 2012 the CSP opposed the introduction of a competitive internal market into the English NHS. We were concerned about both the potential impact on services for patients from changing providers regularly and the potential impacts on members where tendering resulted in changes for them. However once the changes were made, many members said that they didn’t want constant change, so along with other unions and professional bodies we supported members to work within the system.

Nearly a decade later the internal market systems has been shown to fail. In some areas contracts have been handed back by independent providers who could not turn a profit from them. Rationalisation of services has been blocked by competition rules. Financial rules have sometimes prevented cross organisational work to deliver both better patient care and taxpayer savings.

Time for change

Most positive changes have not come from commissioning. For example, the introduction of first contact physios in England did not come about through commissioners procuring better MSK services. So pretty universally professional bodies, trade unions and NHS organisations themselves have said it is time for change.

The Health and Care Bill is the mechanism for making change. The bill ends competition requirements and compulsory tendering of services. Instead it envisages population planning on the basis of community need and on an integrated basis. That is what integrated care systems are for. This won’t prevent the commissioning of services from the voluntary and private sectors but will mean that is a choice based on local need.

The fact that a government of the same party that introduced the original changes is now reversing their own market system has led to some scepticism. Some fanciful claims have been made about the rationale for the changes as a result. But the reason a government not ideologically disposed to reform is acting is simple in our view. If health and care fails to meet public needs voters will punish them at the polls.

If the current system continues the NHS will fail to meet the changing needs of the population and will be unable to deliver the NHS Long Term Plan.

Playing shops needs to go and integrating across acute, community, primary and social care needs to be the norm

CSP support

The CSP, along with many other membership bodies, has supported the bill in principle. There are things we want to see strengthened, however. The CSP is lobbying for more rigorous national and ICS level workforce planning informed by professions and unions.  We want to see both AHP and rehab leads on ICS boards. We want to see stronger commitments to health equality, too.

We have already had some success. NHS England’s clinical and professional leadership guidance for ICSs is very clear that AHPs need to be included in leadership. It also explicitly recognises the need to involve professional bodies in considering service changes. This very much opens a door for physios to assert their place in leadership and to demand involvement in change.

In coming months we will be providing advice on how members can influence their emerging ICSs. The fact that they are locally focused and will make different decision based on local factors means this will be a challenge for us all.

In the meantime, our regional staff teams are mapping who is who in the shadow ICSs. Two are headed by physios. If you are involved at any level please do get in touch with your regional senior negotiating officer, professional adviser, organiser or campaigns and engagement officer.

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