23/10/2019

The NHS wants the Government and Parliament to introduce new legislation to free up different parts of the health service to work together and with its partners more easily – and so speed up implementation of the NHS Long Term Plan.

But this new regime risks excluding independent and voluntary sector providers from the planning, implementation and delivery of integrated care.

Part of the problem is public discourse over independent sector involvement and partnerships in the NHS. Much of the current mantra is that ‘public sector is good’ and that the ‘independent sector is bad’.

The Long Term Plan provides an ambitious vision of healthcare in which the patient is at the centre of decisions about their own care and that care fits around patients. It is important, therefore, to ensure that any changes to the system enhance patients’ ability to choose and access a range of different services and sources of support.

Public and independent service providers both have a role to play in delivering a diverse and comprehensive health and care economy, and the goal should be arrangements that favour collaboration and quality because what matters most to patients is that providers deliver services that put their needs the centre of the delivery model.

So, it is crucial that integration comprehensively involves services provided by health and by social care providers at all levels in the system (primary, community, secondary, tertiary, specialist); by type of services within health and social care and by type of provider (public, independent and voluntary).

To deliver new models of care will also require bringing together commissioners and providers from all parts of the system. But current conversations are not sufficiently inclusive with local government, the independent and voluntary sectors. This means there is a danger of monopoly models of healthcare developing that exclude independent sector companies.

There is also a lack of a clear regional tier to help interpret some of the instructions from national bodies and make them clear, concise and consistent at a local level. As many commentators point out - we have lost some of the connective tissue in the system.

The NHS needs to work with all parts of the system in order to deliver truly integrated services and this includes the independent sector. There needs to be change in the narrative around public and independent sector services, with perhaps some better education around what integration and patient choice actually mean for patients, and the part that the independent sector plays in the delivery of NHS services.

More effort is needed to change professional and public opinion that independent sector involvement in the delivery of NHS services should be resisted. There also needs to be some effort in bringing everyone on the journey to change the narrative around public sector = good and independent sector = bad, with a recognition and understanding that the NHS has always been a public/private partnership.

Whether the recommendations put forward by NHS England and NHS Improvement become law or not, the continued progress of integration in the health and social care system seems to be a certainty. However, questions remain around how this will work, and what mechanisms will be put in place to ensure citizens can effectively exercise choice over where and by whom they are treated. Whatever the result, it is essential that meaningful arrangements are in place to ensure integration is open to the full range of provider organisations so that the benefits of full collaboration are realised.