Suspend NHS competition rules in London to allow for urgent remodelling of healthcare, says think tank

BMJ 2013; 346 doi: (Published 26 June 2013) Cite this as: BMJ 2013;346:f4120
  1. Matthew Limb
  1. 1London

London should be exempted from the NHS regulatory regime in England so that its health services can be radically and urgently remodelled, a healthcare think tank has said.

The King’s Fund said that rules on competition and mergers would have to be either “changed substantially or suspended” to allow trusts to collaborate and set up integrated service networks.

The fund’s chief executive, Chris Ham, said, “Without change, London’s health system is at risk of becoming financially unsustainable, and patient care could suffer.” He said the structures set up by the current government were “not fit for purpose” and couldn’t deliver the improvements that were needed.

The King’s Fund has set out the ideas in a report, Leading Health Care in London: Time for a Radical Response, published on 26 June.1

It said that pressure on London’s hospitals was growing—that the city probably had “too many” hospitals and that it had four of England’s five most financially challenged NHS trusts. London also has “underdeveloped” primary care and wide variations in outcomes and the quality of care.

The report suggested moving to a new system along the lines of the Veterans’ Health Administration in the United States, which faced similar issues and had to be transformed. Under the proposal London would have three “provider networks” that would be based on the footprint already established by the academic health sciences networks and a city-wide funding and commissioning body. Network leaders would have “freedom to reconfigure services,” which could involve reducing acute capacity and ensuring major investment in out of hospital care.

The King’s Fund said that vital change was being delayed because no single body was responsible for leading it in a fragmented system with many organisations whose “remits are not always clear.”

It said that the government may find it “unpalatable” to vary or suspend competition rules, but the banking crisis of 2008 set a precedent for such action.

Ham, who cowrote the report, said that it highlighted many problems facing the NHS as a whole, although London’s problems were particularly complex and urgent.

“Courage will be needed to implement a radically different approach capable of delivering the changes required,” he said.


Cite this as: BMJ 2013;346:f4120


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