Commissioning

Hancock sceptical of overreliance on choice and competition: ‘The NHS isn’t a private market’

Health and social care secretary Matt Hancock has backed a systemwide rupture from the NHS’s decades-long history of purchaser/provider splits and has thrown his support behind an integrated commissioning framework which prioritises collaboration rather than choice and competition.

Speaking with NHS Providers chief executive Chris Hopson, Hancock described himself as an “iterative reformer” more than anything else.

He sees the role of secretary of state as to set a common direction, fight the NHS battles in Whitehall, communicate where we’re going, and handle major crises. But he also keen on pushing the NHS to go above and beyond its achievements thus far, especially in the realm of technology, where Hancock wants to see a keen focus on interoperability.

“Health is one of the few areas in life that, when there are improvements and improvements in technology, that seems to cost more. But that isn’t necessarily certain. With the new generation of technologies coming onstream, we can improve care and improve the lives of the people working in the NHS and reduce, not increase, costs,” he explained. “I don’t really recognise a binary tension between transformation and long-term financial sustainability.”

During his interview, Hancock also argued that, despite his broadly free market background, he recognises that enforced competition in areas where you can get more value out of collaboration only helps to put in place siloes and boundaries that mitigate against people working together – a phenomenon he is keen to reduce.

Asked by Hopson how that view on enforced competition ties back to the purchaser/provider split – first introduced in 1990 – Hancock suggested that it will affect how commissioning is carried out in future as the landscape of the NHS evolves.

“Commissioning is very, very important, and the split between commissioners and providers is important because you need to keep a financial grip on the system,” he explained. “The question is, at what level do you commission? The concept of an integrated care provider is that you are commissioning at one level higher, over a geography rather than for individual services.

“I’m instinctively in favour of using commissioning to keep a grip on the system and make sure we get value for money, but I’m sceptical of using those mechanisms where the siloes that they require are a barrier to improving things on the ground.”

The health and social care secretary said he cares about choice at an individual level – such as the ability to change a GP provider, or receive treatment from a specific hospital – but at a system level, whilst it does have some value, a joint competition framework “leads to some significant downsides.”

“This isn’t a market in a private sense because people don’t go out of business, and whilst I love to see some new providers coming on-board, that’s pretty rare,” he continued. “If you take away those two facts, then you can’t just rely on choice and competition; you want to have enough commissioner grip to have individual choices for patients alongside their core professionals, but we have to make it easier for people to work together across the siloes.”

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