1. Make the NHS the default for NHS contracts and tender competitively if not; 2. Ensure governance by those whose fiduciary duty is to patients rather than to shareholders. 3. Retain the duty on the Health Secretary to provide a high quality health and care service, free at the point of use.
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The NHS as a universal benefit, tax-funded and free at the point of use is a fundamental part of the UK's social contract. The Bill, as drafted, would give ministers the ability to modify governance and funding at will and migrate towards quite different systems including a US-style system (which is the worst performer in terms of effectiveness and efficiency, but the highest profit generator, in the developed world).
Friday 29th October 2021
Protecting the NHS is of the utmost importance to the Government. We are committed to ensuring the NHS continues to provide excellent care that is free at the point of need for generations to come.
The Health and Care Bill delivers on the NHS’s own proposals for reform in its 2019 Long Term Plan, and makes permanent some of the innovations we have seen in the system as a result of Covid. It captures learning from the response to the pandemic and the vaccine rollout. And it goes even further, with a range of measures to level-up health outcomes across the country, enabling people to live longer and healthier lives.
The NHS has told us that the current competition and procurement rules are not well suited to the way healthcare is arranged. We are therefore changing the way the NHS arranges services in a way that provides more flexibility, reduces bureaucracy for both commissioners and providers and reduces the need for competitive tendering where it adds limited or no value.
The proposed new regime is being designed to allow transparency, scrutiny and due-diligence in decision-making, but without the barriers and limitations associated with running tender exercises.
The vast majority of NHS care has and will continue to be provided by public sector organisations. However, successive Governments of all political affiliations have allowed the NHS to commission services from the private and voluntary sector. Whether that is to improve accessibility and experience for patients, to increase capacity quickly, or to introduce innovation, NHS commissioners may commission services to meet the needs of their local area from any CQC-registered provider, regardless of their corporate status, provided they follow procurement rules and regulations.
We want to ensure that care is delivered in the best interest of patients, and it is the view not just of this Government but of the NHS that local commissioners are the best people to determine what services a local population needs.
Commissioners will continue to be responsible for managing contracts to ensure services are arranged with all providers, including those with the independent sector, to provide high quality of care at efficient prices.
The Bill establishes Integrated Care Boards (ICBs) to take on the commissioning functions of existing CCGs and some of NHS England’s commissioning functions. They will be directly accountable for NHS spend and performance, and will be NHS bodies. They will bring in representatives from a range of other NHS bodies including NHS commissioners and NHS providers. Local areas may choose to involve a range of providers, including the voluntary and independent sector, in their Integrated Care Partnerships. However, the work of ICBs will be driven by health outcomes, not profit.
It has never been the intention for independent providers, as corporate entities, to sit on Integrated Care Boards, nor for an individual to be appointed there to be a representative of such an interest in any capacity. The new commissioning bodies being set up are all public bodies and will not, and indeed cannot, be controlled by private providers. The Bill, as drafted, already provides for this.
The work of Integrated Care Boards is driven by health outcomes, not by profits. There are safeguards in place to ensure that the interests of the public and the NHS are always put first. The ICB chair has the power to veto members of the board if they are unsuitable, and NHS England has the power to issue guidance to ICBs in relation to appointments as part of its general guidance-making power. That sits alongside the robust requirements on ICBs to manage conflicts of interests, and NHSE’s wider duty to issue guidance to ICBs.
To put this matter beyond doubt, the Government is proposing to bring forward specific rules to protect the independence of ICBs by preventing individuals with significant interests in private healthcare from sitting on them.
NHS England will remain accountable to the Secretary of State and Parliament. The Health Secretary has duties, including to the continuous improvement of quality of services, and to the NHS constitution, which as one of its guiding principles has that NHS services are free of charge, except in limited circumstances when sanctioned by Parliament. Access to NHS services is based on clinical need, not an individual’s ability to pay.
The NHS is and always will be free at the point of use. The government has been steadfast in its commitment to the guiding principles of the NHS which mean the NHS is not and never will be for sale to the private sector.
Department for Health and Social Care