18.02.15
Integrated care commissioners need ‘waiver’ to bypass procurement rules
NHS England and Monitor should review current rules on procurement and tendering to remove any barriers to the development of new care models, a new report has suggested.
The study by the King’s Fund has called for fundamental changes in how health services are commissioned, paid for and regulated to deliver the vision set out in the NHS Five Year Forward View.
It has also been suggested that, where appropriate, NHS England and Monitor should provide a waiver to enable commissioners to depart from procurement and tendering rules.
The think-tank said that the Forward View looks to a set of early adopters to explore and develop the new models of care and provide learning for the rest of the NHS.
Therefore, national bodies should clarify as “a matter of urgency” how they expect early adopters to do this while not falling foul of rules on procurement and tendering.
It was added that, in some cases, national bodies should consider giving commissioners and providers a waiver to depart from rules that are barriers (real or perceived) to the development of new care models. For this to happen, there needs to be “greater clarity” about the scope for waivers in relation to EU rules and how these are changing.
The report added that there is also a case for making central legal advice available to local areas as they develop and implement their plans.
Chris Ham, chief executive of The King’s Fund and lead author of the report, said: “The NHS Five Year Forward View offers a compelling vision for how NHS services need to change but risks gathering dust on the shelf unless fundamental changes are made to the way health services are commissioned, paid for and regulated.
“While NHS leaders will understandably be tempted to focus on dealing with short-term pressures, the reality is that improving operational performance and implementing the changes to services outlined in the Forward View are two sides of the same coin – both must be priorities if the NHS is to confront the challenges it faces.”
Many of the models of care outlined in the Forward View require care to be much more integrated than it is now. However, one of the challenges in migrating towards these new models is to ensure that the behaviour of the regulators facilitates their development.
It has been recommended that, in the future, the Care Quality Commission’s work should focus on assessing how well care is integrated across local systems rather than just inspecting individual NHS organisations.
While innovations in commissioning are still in development, the King’s Fund says it is too early to draw firm conclusions. However, it believes the process of developing prime contracts, alliance contracts and related approaches needs considerable investment of time and resources to develop effective relationships between commissioners and providers.
The think-tank adds that innovations in commissioning create opportunities for risk-sharing between commissioners and providers. This is particularly important in a cash-limited and increasingly cash-strapped NHS where gains in one part of the system may create problems in another part.
It was suggested that national bodies should support NHS commissioners to implement new forms of commissioning and contracting. This should include establishing a community of practice to share learning and expertise, and offering expert legal and other advice.
To view the full report, click here.
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