COMPETITION used to be a dirty word to socialist politicians back in the 1980s in the days of Margaret Thatcher’s Tory Government, GP fundholding, and the split between purchasers and providers in the National Health Service.
Competition could never lead to co-operation, insisted the then Labour shadow health spokesmen. Patients must be put before profits, care before cash.
Now it appears that Labour frontbenchers have changed their minds. Competition is what the NHS is now all about. Co-operation and competition go together and even “drive up quality”, according to health minister Ben Bradshaw. So much so that, since the end of January, we have had an NHS Co-operation and Competition Panel whose job is to advise strategic health authorities, the Department of Health and Monitor (which regulates foundation trusts) on resolving disputes relating to competition for NHS-funded services.
According to its website the panel “helps support the delivery to patients and taxpayers of the benefits of competition”. Are there any benefits of competition in an equal service for all patients that is the cornerstone of the NHS?
Apparently: “The CCP’s approach is grounded in the established principles of economic and competition analysis.” Nye Bevan would be turning in his grave. But at least the explanation goes on: “However, in applying these principles, the CCP ensures that it takes account of the special features of the healthcare sector, such as it being free at the point of service for patients, the not for profit nature of many organisations providing healthcare services and the help many patients need to make informed choices between service providers.”
Or, as NHS chief executive David Nicholson puts it, the job of the CCP is “to complement [sic] the role of strategic health authorities and provide advice as to compliance with the overarching rules in individual cases….SHAs [strategic health authorities] retain responsibility for strategic, competitive and comparative oversight in their locality but now have the additional support offered by the Panel to ensure the NHS has effective governance and oversight and operates in the best interests of patients and taxpayers.” That explains it all clearly, then.
I feel obliged to point out that there was a grammatical error in his letter to the NHS in which Nicholson added an apostrophe before the “s” in SHAs, which has been corrected here.
But surely if there was not competition for NHS-funded services, if the health service ran its own services as it always used to, there would be no need for yet another non-statutory, independent advisory body.
The Co-operation and Competition Panel is one of
42 such quangos (officially known as non-departmental public bodies or NDPBs) set up by the Department of Health. Thirty-one of them are advisory (including this panel) and the other 11 are executive NDPBs carrying out administrative and regulatory functions rather than just providing independent expert advice.
The Commission for Healthcare Audit and Inspection or Healthcare Commission is yet another Department of Health NDPB. It was set up in 2004 as the independent watchdog for healthcare in England to assess and report on the quality and safety of services provided by the NHS and the independent healthcare sector, and work to improve services for patients and the public.
However, like so many NDPBs, it has had a short lifespan – just five years. It will be scrapped in April. But at least it lasted a year longer than the NDPB it replaced, the Commission for Health Improvement, which only lasted four years.
The Healthcare Commission is being replaced by another NDPB, the Care Quality Commission. This super-quango will also swallow up the work of the Commission for Social Care Inspection and the Mental Health Act Commission.
It is all very confusing and how long will this new super-commission last? At the current rate, I would say six years at the most. Unless, of course, there is a change of government at the next election, after which, once again, the NHS is sure
to be shaken up, changed and reformed.
The far-reaching authority of the Care Quality Commission is to regulate the quality of health and adult social care throughout England, making it one of the most powerful bodies in the NHS. Its chair, Barbara Young, will be one of the most influential people in the health service.
Similarly, the Co-operation and Competition Panel is set to wield considerable clout, thus ensuring its chair, Patrick Carter, has one of the hottest seats in healthcare.
Lord Carter of Coles and Baroness Young (both Labour peers) together with William Moyes, chairman of Monitor, the independent regulator of foundation trusts; and Andrew Dillon, chief executive of the National Institute for Health and Clinical Excellence, which approves drugs for use in the NHS will hold huge potential power over the future direction of the health service.
Yet the most influential and powerful of all may be Ara Darzi, a highly skilled surgeon and professor of surgery who was pushed into the cut and thrust of health service politics by Gordon Brown. As junior health minister in the House of Lords, his impact on the NHS has been overwhelming.
Lord Darzi’s landmark report, Our NHS, Our Future: Next Stage Review, saw clinicians and managers throughout the NHS jumping to attention, desperate to fulfil his demands, anxious to get his approval. It contained many good ideas, many positive changes, but also too many buzzwords and too much Department of Health jargon.
We can only hope that the NHS as we know and love it is safe in these five pairs of hands. Personally, I am not confident.
