Health department won’t be able to show preference between NHS and private providers of health services

BMJ 2011; 342 doi: (Published 28 June 2011) Cite this as: BMJ 2011;342:d4111
  1. Adrian O’Dowd
  1. 1London

The Department of Health will not be able to show a preference for NHS, private, or voluntary sector providers of health services or promote one over any other, under new amendments to the planned reforms of the health service in England.

A briefing on the amendments, published on 27 June, state that the health secretary, the regulator Monitor, and the NHS Commissioning Board (which will oversee the new commissioning groups) will be prevented from using their abilities “for the purpose of increasing or decreasing the market share of any particular type of provider—whether public or private sector—in the provision of NHS services.”

This will prevent policy decisions made in the past from happening again, such as the decision by the former health secretary Andy Burnham that the NHS should be the “preferred provider” of services (BMJ 2009;339:b4085, doi:10.1136/bmj.b4085).

The department has published a briefing on its 180 amendments on how the Health and Social Care Bill is to be altered to take into account the recommendations of the NHS Future Forum, the independent body set up by the government to review the planned reforms, which reported back on 13 June (BMJ 2011;342:d3769, doi:10.1136/bmj.d3769).

The department says that with the new amendments the government believes that what matters is the quality of services for patients and not the “ownership model of the provider.”

The amendments also say that a blanket deadline of 2014 for NHS trusts to become foundation trusts has been amended. However, it adds that the health bill still means it will not be an option for NHS trusts to remain as such and that they will have to become foundation trusts eventually, so tests set by Monitor to approve this change would remain.

Worries over so called “quality premium” payments that the original bill proposed for what were to be GP commissioning consortiums and are now called clinical commissioning groups are dealt with in the amendments. They say that greater transparency is needed over the purpose of the payments and that they will be based on performance against outcomes relating to the quality of services and reductions in inequalities. Clinical commissioning groups will have to publish details of how the payments have been used, and the NHS Commissioning Board can reduce or withhold a payment and impose conditions about how the payments can be used.

The BMA’s chairman of council, Hamish Meldrum, speaking at the BMA’s annual representative meeting in Cardiff on Monday 27 June, said that the BMA was examining the 180 government amendments in minute detail (BMJ 2011;342:d4090, doi:10.1136/bmj.d4090).

He said, “There is still a lot to play for, still much detail to be devilled out, still much else we want to change—indeed we must change, but we should be careful not to make the mistake of dragging defeat from the jaws of victory.”

A spokesman for the healthcare think tank the King’s Fund said, “The amendments proposed by the government will significantly improve the bill.

“The key priority facing the NHS remains the need to find £20bn (€22bn; $32bn) in productivity improvements to maintain quality and avoid significant cuts to services. The uncertainty of the last few months has caused instability within the NHS at a time when it faces significant financial and operational difficulties.”


Cite this as: BMJ 2011;342:d4111