There is much discussion about The Regulations (section 75), due to be debated in the House of Lords on Wednesday, 24th April, which set the rules for how the new Clinical Commissioning Groups (CCGs) should commission NHS services.
Like many others, we are concerned about the unintended negative impact of the new procurement regulations. In their current form, they pose a threat to charitable providers of NHS healthcare who provide highly valued and highly specialised care.
We are not against competition and support a mixed economy in healthcare, particularly where it serves patient interest. However, the Regulations as currently worded could have an unintended impact on voluntary sector providers of health services and could lead to all contracts being tendered. This will place huge administrative and financial burdens on CCGs, who are likely to seek to bundle contracts to reduce the financial and administrative impact of competitive tendering. This is what currently happens in local government, where competitive tendering is mandatory.
Most charitable providers will not have the resources to bid for these contracts and risk being squeezed out of the market. The consequences will be passed on to patients and local communities, who will lose out on the charitable funding that voluntary sector providers invest in patient care on top of their NHS funding.
Charities are not the same as other health and social care providers. Our purpose, motivations and governance clearly differentiate us. The reality is that what works for private sector providers and NHS Foundation Trusts when it comes to the commissioning of services, may not work for charities.
We are governed and bound by our charitable objectives, which determine and limit exactly what we can do. The vast majority of charities providing services are not generic health and social care providers, but rather deliver specialist, targeted services.
In addition to delivering services, many charities pride themselves on the ‘added value’ provided in addition to delivering on the contract for the patients and their families.
If voluntary sector providers were forced from the market, the NHS would struggle to meet the gap left by the absence of charitable funding and this would be bad news for patients. For example, when Marie Curie provide end of life care, we fund up to 50% of our NHS work from our own charitable funds. We also invest in end of life research, which helps to improve end of life care for patients, their families and their carers. We also add value to local communities through opportunities to volunteer.
Similarly, over 218 independent hospices across the UK do the same – working constantly to raise charitable funds to invest into patient care and to drive innovation in the way in which they care for terminally ill people and their families. For many, to bid for large bundled contracts is likely to be beyond their scope and also their mission.
We know that the Government does not want to exclude voluntary sector providers from delivering NHS services. The prime minister and members of the cabinet have repeatedly stated they want voluntary providers to play a vital role in the newly reformed NHS. It is simply that those responsible for drafting the regulations have not thought through all of the consequences of the current wording for charity sector service providers.
Without a revision, the real loser will be patients and their families who risk losing access to essential, high quality services which are built around their needs and commissioners may lose millions of pounds worth of added value that the charitable sector brings.
Ideally, we would like the Government to re-write the Regulations again and ensure, this time, that they clearly state that CCGs will be able to work with a single preferred provider, where this is directly in the patient’s interest.
This is why we are urging the House of Lords to consider the impact of the regulations on the voluntary sector when they debate the regulations on 24 April.