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Collaboration, not competition, is key to tackling healthcare challenges

24 June 2019

Collaboration, rather than competition, is a better way for the NHS and the wider health and care system to respond to today's challenges, says the Health and Social Care Committee in its report on the NHS Long-Term Plan: legislative proposals.


The NHS Long-term Plan: proposals for legislative change Report welcomes, in principle, NHS England and NHS Improvement's proposals to promote collaboration, especially the proposal to repeal section 75 of the Health and Social Care Act 2012 and revoke the regulations made under it.

The Committee believes that collaboration, rather than competition, is a better way for the NHS and the wider health and care system to respond to today's challenges.

Competition rules add costs and complexities, without corresponding benefits for patients and taxpayers in return. Choice and competition can help raise standards and encourage innovation, but, as an organising principle, collaboration is a better way to manage the rising demands on health and social care, improve joined up care for patients and deliver better value for taxpayers. However, the NHS should not become a monopoly as this would not be in the best interests of patients.

Integrated care

The Report also recommends that the law should rule out non-statutory providers holding an Integrated Care Provider (ICP) contract. Until the law is changed, the Committee strongly urges that any ICP contract should be held by an NHS body.

In addition, the Committee supports the proposal to give the Secretary of State powers to create new NHS trusts, but this power must not be used by the Department or national bodies to impose a form of integration on local health and care services or as threat to force organisations to collaborate.

Now is not the right time to establish integrated care systems as separate legal entities as the committee was told that doing so would involve far wider legislative changes and there is no appetite for another major reorganisation of the NHS. These new systems must however demonstrate the highest standards of openness and transparency.

NHS leadership

The NHS at a national level must support, encourage and empower local leadership. Local areas are working hard to collaborate and integrate care around patients but too often having to do so in spite of rather than with assistance from current legislation which is why legislative changes are necessary to remove some of the hurdles.

While the Committee supports – in principle – the proposal for NHS England and NHS Improvement to merge, concerns have been raised about the degree of central control that could result from this merger. The Committee would like to see more detail on how any unintended consequences of this merger will be avoided.

Cross-party endorsement of legislative proposals

Dr Sarah Wollaston MP, Chair of the Health and Social Care Committee, says:

"The pragmatic proposals we heard throughout this inquiry are broadly welcome. This Report also represents cross-party endorsement of suggested changes, and presents an opportunity to make integration easier, to encourage greater collaboration and reduce some of the burdens from competition rules.

Nevertheless, the proposals in their current form are NHS-centric – we would like to see greater consideration of the wider system which the NHS seeks to integrate.

It is clear that there is no appetite for another large-scale, top-down reorganisation of the NHS and within the current hung Parliament any such major change would not pass the House of Commons. These proposed reforms are being led by the NHS itself and I hope will receive cross party support.

Local health providers continue to work to collaborate and integrate care around patients, in spite of current legislative obstacles and these proposed reforms are designed to remove some of the barriers that can get in the way

We hope the incoming Prime Minister will support the need for reform and that a commitment to take this forward will form part of the next Queen's Speech. The Committee looks forward to conducting pre-legislative scrutiny."

 Further information

Image: PA