Conferences, cancer drugs & competition – new NHS developments

Elliot Bidgood, 1 October 2013

The Liberal Democrats and Labour have each now held their autumn conferences. Lib Dem Care Minister Norman Lamb led a debate on “Dignity at Home: Transforming Home Care” and, encouragingly, stated he had no “philosophical position about who provides care” in the NHS – a March 2013 Civitas poll suggested the public may share this view. Meanwhile in Brighton, Labour Shadow Health Secretary Andy Burnham reiterated his bold ‘Whole-Person Care’ plan to bring about integration by merging health and social care budgets, but also vowed to repeal competition rules and make NHS organisations ‘preferred providers’. He also pledged a “single digit” cap on Foundation Trust earnings from private activities (49% at current).

Later today, Health Secretary Jeremy Hunt will address the Tory conference in Manchester, before its conclusion tomorrow. Hunt will be announcing a pilot scheme involving more use of telehealth and GP surgeries opening from 8am to 8pm, a measure The Spectator says is calculated to demonstrate that Hunt will “drag the NHS into the 21st century and make it work for patients”. Incidentally, Civitas contributor Anton Howes has explored similar themes in his new proposal for the creation of trade union or mutual-led Patient-led Commissioning Groups and even suggested that an example of the policy in practice could be that “a [patient-led] commissioning group made up of workers in a particular industry may commission work-friendly and night-time opening hours”. Hunt is also expected to talk more about the Department of Health’s announcement on Saturday that the government intends to extend the life of the Cancer Drugs Fund, introduced in 2011 and currently set to end in 2014, to 2016.

Meanwhile, last week the Health Service Journal revealed that at a Commissioning Summit outgoing NHS Chief Executive David Nicholson acknowledged the growing concerns of some health professionals that the coalition’s current competition rules, while certainly intended as a valuable “tool to improve quality for patients”, are at times creating legal issues and inhibiting vital attempts by NHS organisations to either integrate or reconfigure services. I briefly discussed this potential tension in a report in July, After Francis. Andy Burnham, while wrong on ‘preferred provider’ and near-outright opposition to competition, has quite fairly drawn attention to some of these cases recently, and there is a basis for competition rules to be amended to reduce conflicts – the HSJ speculated that coalition ministers may even have to make legislative changes.

This shows the complexities of the relationship between the laudable twin aims of integration and competition – both are important and can be mutually complementary under the right circumstances, but they can clash under the wrong ones. It may be the case that cross-party discussions on this complex issue and a nuanced agreement could plug some of the holes in the competition agendas of both the opposition and the coalition – such a long-term consensus is vital if care in the NHS is to be improved and the service’s future financial sustainability assured.

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