The most vocal opposition to the Health and Social Care Bill came from those who accused the government of privatising the NHS. Others have expressed concern that the private sector might cherry-pick less complex patients, and that competition for patients under any qualified provider would lead to fragmentation. Many of these arguments are based on misunderstandings about how the system currently operates and the likely impact of the proposed reforms.
The debate often assumes that the NHS is a public sector monopoly. Yet in our report on the voluntary sector in health and social care, published today jointly with the National Council for Voluntary Organisations, we report that the statutory sector already spends around £3.39 billion on health services provided by the voluntary and community sector. The private sector is an important provider albeit a relatively marginal one: it is estimated to provide 3.5 per cent of operations funded by the NHS.
Some of those in the private sector have expressed doubts about whether the role of the private sector will grow much above its current level. Certainly the financial position of the NHS makes expansion in the acute sector out of the question. The government's announcement that it will introduce choice of any qualified provider in a 'much more phased way' also suggests that whether new opportunities open up for the private and voluntary sector to provide NHS-funded care will largely depend on commissioners.
The government has made it clear that 'what matters is the quality of care, not the ownership model'. Will commissioners agree?
A breakfast debate we held this week on diversification identified many barriers to the voluntary sector playing a fuller part in the health and social care system. Victor Adebowale, Chief Executive of Turning Point, a leading not-for-profit provider of health and social care services with a turnover of around £70 million, said there are widespread misperceptions of the not-for-profit sector.
Deborah Evans, chief executive of a primary care trust in the South West that has awarded contracts to innovative partnerships between the NHS and the voluntary sector told us that in her mind, it is key that commissioners should be predisposed to working with the private and voluntary sector, as well as having confidence in the good governance, capability and capacity of all providers.
The government is now rightly emphasising the value of integrated care for patients and the need to support clinicians and organisations from all sectors to work together to deliver this. It will be imperative to create a health system in which a diversity of providers is able to deliver integrated care to patients. Ultimately it will be commissioners, clinicians and patients who determine which providers best meet their needs.