Phil Hunt explains why tonight’s debate on the government’s health competition regulations is a crucial moment for our NHS
Today, the House of Lords gets a chance to put a brake on the government’s determination to shift the culture of the NHS from a public service into a public market place.
Peers will be voting on Labour’s motion to annul the Section 75 NHS competition regulations which will force Clinical Commissioning Groups (CCGs) to tender out most NHS services. The new regulations underpin the full panoply of economic regulation, enforced competition and the wasteful and highly expensive cost of tendering.
It is being done in the face of international evidence suggesting that the kind of market the government is embracing is wasteful, leads to perverse treatment incentives and is the very opposite of the integrated approach needed to produce high quality services. Indeed, the highly respected US Commonwealth Fund’s study of different health systems has shown that compared to the US, the NHS scores heavily on quality, access and efficiency.
During the passage of the Health and Social Care Bill, many concerns were raised that CCGs would be forced to tender out all services. Ministers were forced to pledge that doctors would be free to commission services in the way they consider best. Parliament was assured that clinicians would be under no legal obligation to create new markets.
But the regulations being debated in Parliament tonight provide no such re-assurance. The Lords highly respected Scrutiny Select Committee has reported that many NHS professional institutions believe the regulations make competition the default approach, while imposing a burden of proof on commissioners wishing to restrict competition.
The core of the debate will focus on Regulation 5. This makes clear that a competitive tender process is only avoidable where the services to which a contract relates can be provided by a single provider. Legal experts believe there will be very few circumstances where only one provider would be available; for example, the case of a single rural hospital which is the only provider for acute services in a large geographical area. It can never apply in a city like Birmingham or London because there will always be multiple providers.
Hence it will not be left to commissioners to decide as the Minister assured the Lords.
Commissioners will be required to undertake a competitive process in all cases where there is a remote possibility of more than one provider. If a contract is let without competition, an aggrieved party can complain to Monitor, the economic regulator for the NHS. Ultimately they can go to the courts. Indeed, there is a real risk that it will be the courts rather than doctors who will decide the extent of competition and the tendering of services.
The public will never forgive the government for undermining one of the nation’s most popular services. That’s why it is essential that Peers support my motion to kill off these regulations.
Lord Phil Hunt of Kings Heath is a Shadow Health Minister and Labour’s Deputy Leader in the House of Lords
Published 24th April 2013