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A medical student’s perspective as legislation seems finally set to reverse the NHS’s competition model.

Early 2012. I was preparing for medical school interviews. One of the subjects I thought was bound to come up was the newly-passed Health and Social Care Act, led by the then Secretary of State for Health, Andrew Lansley. I spent hours trying to understand the changes resulting from one of the biggest shake-ups in NHS history. Primary Care Trusts and Strategic Health Authorities were out. Clinical Commissioning Groups were in. Competition was heralded as the means to improve service provision.

For some, the Act was a welcome change – GPs would be given greater decision-making powers, able to commission services tailored to their population’s needs. But for others, the Act was a worrying step toward NHS privatisation. So, as I finish my medical degree, what has happened with Lansley’s 2012 Health and Social Care Act?

Change is coming

This week saw the Health and Social Care Select Committee discuss the legislative changes proposed to the 2012 Health and Social Care Act. A diverse range of witnesses were present, with representation from clinical care backgrounds, social care, and local government. Discussions centred on the perceived current barriers to delivering integrated healthcare, and whether the proposed legislative changes offered suitable solutions. A few common themes emerged, outlined below:

 Legislation vs. Policy

The 2012 Health and Social Care Act seeks to improve patient care through competition between care providers. In contrast, recent policy such as the NHS Long Term Plan, seeks to increase collaboration between providers of care. Such juxtaposition between legislation and policy was identified as an area of concern. The proposed legislative changes were felt to address this issue, although it was noted that other areas such as staffing and workplace culture, were important to consider.

Better Together

Recent policy demonstrates the shift in approach from competition to collaboration between healthcare providers. Those present supported the proposed legislation, which was felt to facilitate this shift, although it was suggested there should be a greater role for local governments in the processes. The introduction of a ‘best value test’ (yet to be defined) in the procurement process was viewed favourably. Local government tests were suggested as a basis for these ‘best value tests’, illustrating the potential benefits of collaboration beyond only NHS-bodies.

Don’t force it

It is hoped that the benefits of collaboration will encourage care-providers to come together in order to improve patient care. However, it was recognised that there would be some members unwilling to collaborate. The proposal to manage this situation – giving NHS England the power to impose mergers upon unwilling Boards – was flagged as an area of concern. When a merger could not be agreed, it was felt to be preferable to replace the Board with one more open to such a change, rather than force a Board to merge against its will. NHS England instructing a Board how to act was viewed as poor governance.

Teamwork to make the dream work

The overall impression of the proposed legislative changes was a positive one. Witnesses did not express any misgivings about their involvement in the process so far and were excited at the prospect of future collaborations. For the life sciences sector in particular, understanding how health services are integrating will be important for future planning. For example, the introduction of the newly-created Integrated Care Systems may impact upon applications to local formularies. Further discussions will take place at the next Witness Session of this inquiry, on the 30 April.

The move from competition to collaboration offers the opportunity to pool shared knowledge in order to improve the care patients receive. To adapt a quote from Simon Sinek, author of ‘Start with Why’:

“Changing the world NHS takes more than everything any one person knows, but not more than we know together.”


By Nick Burstow

Decideum Intern and Final Year Medical Student, Imperial College London

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