The writer is chair of the NHS Confederation
The starting gun has been fired on the most significant NHS reforms for a decade and a partial reversal of the market-based reforms introduced by David Cameron’s government in 2012.
The NHS white paper, published in February, was warmly received by NHS leaders. Reorganisations are never top of the NHS’s wishlist, but there is much support given that these reforms will help remove the barriers preventing front-line services from joining up care for the public.
The changes have been a long time in the making. But as we move from high-level white paper to a detailed draft NHS bill, there are many issues that require further examination.
One is what role the government envisages the independent and voluntary sector playing in the future. This has been a bogeyman issue for successive governments, many of which have been accused of privatising the health service despite evidence to the contrary.
Beyond the rhetoric, we believe independent and voluntary sector providers, as well as social enterprises, have a role to play alongside the NHS in providing health and care services.
This partnership role has never been demonstrated more clearly than during the coronavirus crisis. A groundbreaking deal between the government and the independent health sector at the start of the pandemic has led to more than 3.2m operations, consultations, scans, tests and chemotherapy sessions being carried out since March last year.
This followed the impressive progress made in the 2000s, when the Labour government brought in extra independent-sector capacity to work alongside the NHS to reduce patient waiting times from 18 months to 18 weeks.
It is not just in tackling waiting lists that the independent and voluntary sector supports the health service. It has a rich history of working in innovative ways alongside the NHS to improve care for people in need of community care and mental health support.
A new model of community mental healthcare in Somerset is a good example. It is ensuring that anyone with a mental health problem is able to access local specialist interventions whenever needed. The service may not have been possible without the voluntary sector provider stepping in as the NHS was struggling to staff it.
Social enterprises deliver around a third of all community health services and they also play a significant role in the delivery of a host of other services, including out-of-hours care.
Independent and voluntary providers and social enterprises are highly effective at understanding the particular needs of their communities and are therefore well placed to help reduce inequalities. They can often be more trusted than NHS services and play a key role in helping to reduce health inequalities. And we know these will come into sharp focus in the coming months because of the impact of the pandemic.
Despite these advantages, debate over the role of the independent and voluntary sector is again likely to be a flashpoint when the NHS bill is laid before parliament. Ministers will be well served by ignoring the siren calls and continuing to ensure the NHS works side by side with the independent sector as we begin the recovery phase of the pandemic.
This is where the new integrated care systems, a central plank of the proposed reforms, will come into play. Contrary to some reports, the division of responsibilities between those who provide services and those who commission them, a foundation stone of the public management reforms of the past 30 years, will still be evident. But it will be much more blurred than in the past, and procurement rules will change.
This will bring some benefits — such as less friction between providers and commissioners, less bureaucracy and tender processes reserved for when they are needed most. But we will still need to protect and promote patient choice and to avoid local monopolies by working effectively, as we do now, with independent and voluntary sector providers.
These reforms offer the chance to build on the success of the NHS’s co-operation with independent and voluntary providers during the Covid-19 crisis. They also build on decades of working together, helping to sustain a health service that is free at the point of use and available to all based on need and not ability to pay.
We would do well to remember that, during the debates that are about to follow.