Health Care Reform

Collaboration in the NHS is more difficult than ever before

By: Ben Gowland @ccginsider
Published: Monday, September 22, 2014 - 08:08 GMT Jump to Comments

The introduction of different regulators and new competition rules are making collaboration in the NHS increasingly difficult, as predicted by Professor Bob Hudson in 2013

You would think collaboration would be easy.  We expect our NHS to work in a way that starts and finishes with the patient, and so organisations collaborating together for the benefit of patients is an expectation as citizens we rightly hold for our NHS.

In fact collaboration is never easy - for a set of reasons that apply everywhere such as the need for high levels of trust - because the benefits of collaboration do not fall evenly, and because different organisational priorities impact on collaborative initiatives.

But in today’s NHS, collaboration is even more difficult.

There are two main reasons for this. The first is the introduction of multiple regulators. Each organisation operating in a local health economy has their own (different) regulator: Monitor for Foundation Trusts; the Trust Development Authority (TDA) for NHS Trusts; and NHS England for CCGs. These regulators are responsible for ensuring that their organisation is meeting its own requirements. Whether this works for the health economy as a whole is for them only a secondary issue.

This results in occasions when organisations are not able to collaborate in the way that they may want to within the local health economy, because of the instructions they are under from their regulator. To be fair the regulators are aware of this, and are trying to improve it with initiatives such as the tri-partite agreement on winter planning. But the reality is that the dispersion of regulators makes local collaboration more difficult.

The second is the minefield of competition regulations that are now in place. Professor Bob Hudson foresaw some of the problems that the Health and Social Care Act of 2013 was creating, in his must-read article ‘Competition and Collaboration in the ‘New NHS’’ (June 2013). 

He starts at the crux of the issue, ‘The Health and Social Care Act 2012 has placed requirements on the NHS commissioners to engage in both collaboration and competition – but there has been no indication that the two are compatible’.

NHS commissioners must ensure that the interests of people are prioritised over the interests of organisations. But what constitutes ‘patient interest’ is the key issue. The competition regulators have to decide this, and they start with the assumption that choice of providers invariably benefits patients. 

This assumption is what makes collaboration difficult. We got a taste of this with the competition regulators intervention in the proposed merger of Royal Bournemouth and Christchurch Hospitals and Poole Foundation Trust. If collaboration can be viewed as restricting competition in any way, then the competition regulators are likely to be against it.

So Professor Hudson’s prediction back in 2013 was that, ‘What we may witness – at best - in coming years will be guerrilla warfare as public sector commissioners and providers seek ways of working together more closely in the face of legislation and regulations that pull in the opposite direction.’ (p13).

I am not sure I would quite describe it as ‘guerrilla warfare,’ but it does feel like collaboration now has to be achieved despite the new arrangements, not as a result of them. To the neutral observer it might seem self-evident that collaboration between NHS organisations is a good thing, but the reality is that there are now significant hurdles that need to be overcome before it can even be embarked upon. Collaboration is never easy, but in the new NHS it is more difficult than ever before.

Ben Gowland is one end of RealityBites - The National Healthcare Conversation a weekly podcast published every Tuesday on the front page of the Information Daily

The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of The Information Daily, its parent company or any associated businesses.

Comments

Latest

Outdated infrastructure and an increasingly fragmented market threaten the future of technology-enabled integrated care.

County Durham voters back devolution in the North-East, Sir Digby Jones considers run for West Midlands mayor…

The recent launch of The Mayoral Tech Manifesto 2016 on London’s digital future, sets out a clear agenda…

The manufacturing industry is currently facing scrutiny from parties concerned for its survival. Far from facing…

Almost a year ago, I made some predictions for what would take place in government and public sector customer…

Sheffield, Warrington and Doncaster announce cuts, Lincolnshire is held to data ransom, fight begins for West…

Working for an education charity delivering numeracy and literacy programmes in primary schools, I’m only…

Northamptonshire County Council recently received the maximum four star rating from Better connected after putting…

Historically, the entrance of new generations into the workplace has caused varying levels of disruption. The…

Following another commendation for digital services, Surrey County Council's Web and Digital Services Manager,…

We cannot carry on spinning the roulette wheel that is cyber security, knowing that the “castle and moat”…

This week David Cameron wades into row over £69m of cuts planned by Oxfordshire CC; Stoke on Trent plans…