Issues MPs and the media have missed in Lansley’s billBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3194 (Published 24 May 2011) Cite this as: BMJ 2011;342:d3194
All rapid responses
"Any willing provider" vs "any qualified provider" in the NHS reform: different bottle, same contents
PUBLIC POLICY LETTER TO THE EDITOR
Dear BMJ Editorial Team,
Many have the impression that an important change was negotiated
through the alteration of "any willing provider" to "any qualified
provider" in the new version of the Health and Social Care Bill.
Comparison of the procurement guide issued by the DH a year ago with the
legal and operational advice from the NHS Confederation this month,
reveals that the underlying procedure will be identical. This is
explicitly acknowledged by the "Any qualified provider" Discussion Paper
from the NHS Confederation from which the details below are drawn.
The "any willing provider" (AWP) commissioning procedure is set by EU
procurement directive, and the term "any qualified provider" (AQP) does
not exist in EU law. Thus the AWP process has simply been renamed with no
change to its substance. The competitive commissioning process concerned
seems to be identical. The two are compared in this table through excerpts
from the source documents:
This reform represents the completion of the roll-out of competition
throughout NHS-funded provision. All NHS commissioning is a market-based
process covered by EU law on procurement and competition.
If a future government wishes to bring a health or social care
service back into public sector provision (say if the consequences of this
reform turn out to be bad for patients) any existing or would-be provider
may sue under EU law on anticompetitive practices. Dr David Bennett, Chair
and Interim Chief Executive of Monitor, acknowledged this risk to the
Public Bill Committee on 28 June 2011 .
Competing interests: No competing interests
There is very little sense talked in the whole debate on NHS reform
and John Lister doesn't make that any better. Like many other opponents of
reform, for example, he assumes that an NHS that conforms to his ideal
model is more important than outcomes for patients.
So he is very keen on local accountability, for example, though this
is usually one of the major reasons why even strongly clinically justified
reconfigurations get held up to the detriment of patients. It is facile to
assume that democratic is good without having the important debate about
the conflict between what people want and what clinicians judge people to
need. We have know for more than two decades, for example, that units
performing heart surgery on children need critical mass to minimize
deaths. But even now the process of centralising the activity in fewer
centres is bogged down in consultation. Democratic accountability and
consultation sound like universal goods, but they don't solve difficult
problems and their side effects are putting childrens' lives at risk.
He also criticises PCTs who have done their job by drawing up "low
priority" procedure lists. Yet, in the absence of infinite resources, any
conceivable NHS will have to confront the challenge of prioritising where
the limited resources are directed. This is not a problem best solved by
pretending it doesn't exist. And it has nothing to do with reform.
There is a debate to be had on whether competition is good or bad.
Perhaps, for example, shutting an ENT unit at hospital x would leave local
patients having to travel for 2 hours to get to the next nearest hospital.
But perhaps their next nearest is only 5 minutes further away and offers
faster better treatment. The question is not a matter of ideology but of
analysis: we can look at the geography of hospitals and patients and judge
what access the patients need. To assume that shutting any individual
department is a catastrophe for patients in ridiculous. I note that
opponents of reform have not rushed to present any actual analysis (to be
fair neither has the government). Having done this analysis for some
services I'm fairly sure we could see a lot of rationalisation before the
average person in England would notice a major loss of access.
Whatever way we choose to run the NHS we have difficult decisions to
make. Which treatments are worth funding? Where should services be
located? How do we spend the money effectively? Pretending that some of
the proposed answers to these questions are problems of NHS reform is just
obfuscation and the sort of misinformation that Lister accuses the
government of fomenting.
Competing interests: No competing interests