Labour ‘must acknowledge an NHS market’

The government must admit that it wants to create a genuine market in the NHS if its reforms are to work properly, a think tank report warns today.

A study by the King’s Fund says that without more clarity about the future role of the independent sector in providing health care, patient care will suffer.

Substantial investment has already been made in independent providers – a £2.5 billion contract has already been signed with independent treatment centres, while by 2008, about £5 billion a year is expected to be spent on private sector services in the NHS.

Today’s report does not question whether the introduction of the market is a good thing – both Labour and the Conservatives support such a move – but notes there are “great risks” if this market is allowed to operate poorly.

While it notes the obvious benefits in tackling traditional NHS weaknesses such as long waiting lists, it warns that emergency care, the treatment of long-term conditions and the so-called ‘Cinderella’ services, such as mental health, “could degrade, perhaps badly”.

Firstly, it says ministers must accept that in a market, evolution must be allowed to happen rather than changes being imposed from the centre, and that Whitehall must not try to control the day to day running of NHS trusts, but focus on setting basic standards, investment and policy goals.

The new role of primary care trusts (PCTs) as commissioners rather than providers of healthcare services is one example – although the announcement of the shift this year was right, the report says the way it was imposed, rather than allowed to develop, was not.

The existence of a new market-led NHS must also be clearly explained to MPs, the King’s Fund report says, so they realise their main concern should be with protecting the quality of services in the health service, not its institutions.

In addition, it warns that private and independent health providers are currently unsure whether their efforts will form part of a long-term plan for the NHS, or are simply being used as a short-term tool to cut waiting lists, and then will be discarded.

Regulation must also change to make it more concerned with mergers and acquisitions, financial performance and monopolies, the report says, while the NHS IT programme must be accelerated to ensure trusts have the infrastructure to develop properly.

“A supply-side market is being created in health care out of a powerful mix of tariffs, incentives and new providers. This offers tremendous opportunities but it also carries great risks,” said working group chairman Greg Parston.

“A more diverse supply of health care has the potential to enlarge patient choice and drive competitive improvements in services. However, a poorly operating market could damage widely acknowledged NHS strengths and ultimately undermine patient care.”

King’s Fund chief executive Niall Dickson added: “The move towards the introduction of a supplier market has been achieved with surprisingly little serious discussion and there is still some uncertainty about where it is all heading.”

Liberal Democrat health spokesman Steve Webb commented: “The government seems to stumble from one reform to the next with no clear long-term vision, and certainly not one that has been sold to the public.

“If our NHS is to look radically different in a decade, then we have a right to know the direction of travel.”