NHS doesn't stand for "National High Street"

Providers in the new NHS must be free to integrate care in the patient interest, even if this has the effect of reducing competition argues Chris Hopson, the new chief executive of the Foundation Trust Network.

On the High Street, competition law creates a competitive market by ensuring a range of different suppliers, fostering competition based on price, avoiding monopolies and probing vertical integration in the supply chain (for example, supermarkets owning dairies).

But there are other models for preserving the consumer interest which recognise that certain areas of our national life have specific characteristics that require a different approach.

Last month, for example, saw a highly publicised row between two train operating companies bidding for a long term, monopoly, franchise. The franchise deliberately runs for long enough to enable the operator to earn a sufficient return on the expensive infrastructure needed to provide a quality customer service.

Last month also saw the closure of the football transfer window, which restricts the times when clubs can buy new players. Clubs also now have to abide by new Financial Fair Play rules which are designed to create a level playing field by restricting the amount of money wealthy owners can invest to "buy success".

What does all this have to do with the NHS? The Health and Social Care Act, passed earlier this year, marks the next stage in the journey away from a single, all encompassing, command and control health service. It continues work begun by the previous Labour administration to create a more plural system where, in some areas of care, a wider range of providers compete to provide services for patients. As a result, patients have greater choice rather than, for example, being forced to use the closest NHS hospital.

But the health sector is not the High Street. Competition is based on quality, not price, with the price of an increasing range of treatments determined by a single tariff, to be set in future by a central Commissioning Board and the sector regulator. There also needs to be a strong emphasis on integrating care, defined by the NHS Future Forum as "integration around the patient, not the system". The Forum went on to argue that "outcomes, incentives and system rules (i.e. competition and choice) need to be aligned accordingly".

It's easy to see why integrating care is so important. An 80 year old frail patient with multiple problems needs a joined-up network of acute and primary care services where geriatricians, nurses, physiotherapists, and podiatrists all understand the individual patient's needs, and the care provided has no gaps - an integrated care pathway.

Diabetic patients in Bolton now have a centre staffed by specialists that care for inpatients at the local hospital but also care for patients at home by working with GPs. The very GPs who, in future, are likely to have commissioned the centre to provide this service. Elderly patients in several Surrey care homes are visited by hospital based geriatricians who advise staff and help to prevent patients being admitted to hospital unnecessarily.

These are all examples of good, joined-up, care: benefitting individual patients, reducing cost and providing better value for money for the taxpayer. But they do involve integration across the NHS, between different organisations that may be commissioning or competing with each other to provide services. Some might argue this reduces competition.

The Foundation Trust Network, which represents the vast majority of acute, mental health, community and ambulance providers in the NHS, is co-hosting fringe sessions at all the party conferences to explore how the NHS can achieve the right balance between integration and competition. It's an important question as the detailed rules for the new NHS are finalised over the next six months.

We'll also be particularly focussed on the importance of the NHS sustaining a flourishing and vibrant set of public providers over the longer term. The way the new rules are formulated will have a crucial impact here. If we get them wrong, there's a danger, to focus on another cause celebre in the competition world, that these organisations could turn into the dairy farmers of the healthcare sector. They might end up working for payments that do not cover costs; forced to sign up to short term contracts that offer no incentive to invest in innovations that improve quality and efficiency and facing an uncertain financial future.

Chris Hopson is the chief executive of the Foundation Trust Network

Photograph: Getty Images
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Chuka Umunna: Why tolerance is not enough

Against the Trumpification of politics.

It’s still spring, yet 2016 already stands out as one of the ugliest years in modern British political history. It was fantastic to see Londoners choosing hope over fear in May, electing Sadiq Khan as our first Muslim mayor. But David Cameron, having shamelessly endorsed Zac Goldsmith’s dog-whistle campaign tactics, owes those young Muslims who have been put off politics by the slurs hurled at Khan an explanation. How does racial profiling and sectarian scaremongering fit into his One Nation vision for Britain?

Meanwhile, Boris Johnson, one of the best bets to succeed Cameron as our next prime minister, embarrassed Britain on the world stage with a racially charged allusion to Barack Obama’s Kenyan heritage. And my own party has been grappling with a swath of deeply disturbing revelations regarding the attitudes held by some on the left towards Israel and Jewish people. Sowing discord by stigmatising or scapegoating a single faith group or community is profoundly at odds with the British tradition of “tolerance”, but we can’t ignore that this year’s events are part of a rising trend of friction and factionalism.

Last year’s general election should have been a wake-up call. The political and cultural divides between people living in the north and south and urban and rural areas – as well as between working-class and metropolitan sensibilities – appear starker than ever. In May’s devolved elections, Scottish, Welsh and Northern Irish politics became yet more distinct – giving the impression of a kingdom coming apart at the seams. All the while, more and more voices in our national politics seek to pin the blame for the challenges facing our country on a single section of society, whether immigrants, Muslims or another group.

This trend stretches beyond our borders. From Ukip, the French Front National and Austria’s Freedom Party to Podemos in Spain and Italy’s Five Star Movement, new populist parties of the right and left are on the rise across Europe. In the United States, Bernie Sanders is tapping into the energy of Occupy Wall Street, while Donald Trump has emerged as the heir to the Tea Party: a poster boy for division and recrimination.

Trump’s rise should be a warning for us Brits. The New York Times commentator David Brooks has described his success as less indicative of the emergence of a new school of thought, or movement, and more of dissatisfaction with the status quo. Trump’s campaign has tapped into a complex cocktail of grievances, from the loss of manufacturing jobs in a globalised economy to rising inequality and raw anger felt by many white working-class Americans at demographic and cultural changes.

In the run-up to last year’s general election, as I travelled around the country, I was confronted time and time again with the reality that in the UK – just like in the US – people are afraid and angry because the world is changing in ways they fear are beyond their control. Where once they had believed that, if they worked hard, they would get ahead, too many Britons now feel that the system is rigged in favour of those born into opportunity and that those in power have abandoned them to a broken future. What it means to be British seems to have shifted around them, triggering a crisis of solidarity.

We are at a crossroads and may face nothing less than the Trumpification of British politics. In an uncertain and changing world, it is all too easy to imagine that our problems are caused by those who are different from us.

If we wish to follow the fine example set by Londoners on 5 May and choose unity and empathy over division and blame, we must accept that simply “tolerating” one another will no longer do. There is an accusation built into the very word: what you are doing is “other” or “wrong”. As Britain has become more diverse, we have come to know each other less. This makes it harder to understand how people from different walks of life feel about the big issues.

I am a Labour member because I believe, as it says on our membership cards, that, by the strength of our common endeavour, we achieve more together than we do alone. In order to develop the bonds of trust required for this to become a reality, and for our communities to flourish and our democracy to deliver for everyone, we must build a society in which people from all backgrounds actually get to know one another and lead interconnected lives. In this sense, “One Nation” – the land over which all parties seek purchase – should become more than a platitude. It should become a way of life.

Chuka Umunna is Labour MP for Streatham.

This article first appeared in the 26 May 2016 issue of the New Statesman, The Brexit odd squad