New year, new NHS rules

This month, as we explore the leadership and advocacy role of local infrastructure organisations, we're looking at the new changes to buying healthcare services and how this affects the voluntary sector. In this guest blog, Garry Jones, CEO of NAVCA member Support Staffordshire, explores the new changes and what this means for us.

New Year’s Day saw the introduction of completely new rules for the NHS when it comes to buying healthcare services. I can hear your yawns, but please read on, or at least take a look at the details for yourself because this really does have massive potential for the VCSE sector and it really does matter. The new rules were a lesser-known promise in the Health and Care Act which put the new Integrated Care Systems on a statutory footing in mid-2022. For some reason, I spotted the procurement clause and have been waiting with bated breath ever since for the detail because of what they could mean.

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In the same way the Integrated Care System has quietly made a U-turn on NHS competition and switched it for collaboration (not much difference eh?!), these new rules junk the idea of competitive tendering for healthcare services and replace it with a new system based upon local knowledge and understanding. At its most strategic, it’s a potential nirvana for the VCSE sector, but I’m trying not to get carried away, and there are some limits

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But first, the new opportunities. The new rules, known as the Provider Selection Regime, offer three main routes to buying health and care services. Two of these are very interesting indeed. The first is Direct Award, which (amongst the detail) allows commissioners (which includes sub-contracting by health trusts not just the ICB) to make a direct award to a health service provider where there is an existing service in place, without major changes to the service or its value (and this is quite a high threshold) and where quality is deemed to be good. Yes, you read that correctly – if you are doing a good job, they can re-contract with you, without going to open tender or competition.

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VCSE organisations are definitely included as contractors. All NHS bodies are included as contractees. At the moment, it is limited to healthcare services. Social care alone is not included, though where it is reasonable to offer integrated services and the health bit is a majority, it can be included! Goods are not included, only services, but again where goods are an integrated part of the service and in the minority, it’s also okay.

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Then, where the existing service is changing significantly or the quality of the current provider is not up to scratch, commissioners still don’t have to go to open competition. Instead, they can use the Most Suitable Provider process. This allows them to assess the market and award based upon their own judgements. No open competition and potentially no national prime contractors in the frame, if the NHS don’t see them as suitable.

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Again, caveat, the process they follow must be transparent and fair and is open to appeal/challenge, but it leaves massive space for the NHS to take a collaborative co-production approach and then award a service/grant to the partnership they have been working with.

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Lastly, competition can still be used if they want to. But frankly, why would you, when it's so much more time consuming and we all know the perverse scoring and outcomes that have often resulted?

What the new regime does rely upon though is a well-informed commissioner, so building relationships and knowledge amongst NHS colleagues is more important than ever for the voluntary sector. It also doesn’t do much to offset the problems of contracts which have been scaled up too much for local delivery and which are commissioned on a regional or national level – if anything, the new regime could hand more of those contracts straight to national primes. But there is some trend away from this as NHS England hand more powers down to ICSs or regional collaboratives of ICSs.

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It is very new, and the other risk is that whilst the rules permit it, commissioners will remain individually or organisationally risk averse to the newness and the lack of bureaucratic safety net the old system provided. They might keep doing what they know. There is also a risk that relationships become too chummy and NHS folk pick their favourite VCSEs and settle into a comfortable but narrow setup. That is firmly in the court of VCSE local infrastructure, not to allow, either amongst our memberships or for ourselves – we must not become the default service provider, just because it's easy to do.

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It will be interesting to see how this begins to play out in the context of the VCSE Alliances set up at system level, and the relationships with place-based partnerships (where we know the commissioning is going to really be taking place). It will also be interesting to see how the PSR’s definition of “health service” is applied – the potential for this to encompass the widest possible range of activity, and focus on prevention end could be one of the biggest considerations of how much this changes things.

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But concerns and risks aside, this is a genuine game changer, or could be, so ask questions asap for any new commission of service from any part of the NHS, because they can no longer claim it can’t be done differently.

To find out more about what Support Staffordshire do, go to their website here.