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

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Douglas Carswell leaves Ukip to become independent MP

The Clacton MP quits his party but insists he will not rejoin the Conservatives or trigger a by-election. 

Douglas Carswell has long been a Ukip MP in name only. Now he isn't even that. Ukip's sole MP, who defected from the Conservatives in 2014, has announced that he is leaving the party.

Carswell's announcement comes as no great surprise. He has long endured a comically antagonistic relationship with Nigel Farage, who last month demanded his expulsion for the sin of failing to aid his knighthood bid. The Clacton MP's ambition to transform Ukip into a libertarian force, rather than a reactionary one, predictably failed. With the party now often polling in single figures, below the Liberal Democrats, the MP has left a sinking ship (taking £217,000 of opposition funding or "short money" with him). As Carswell acknowledges in his statement, Brexit has deprieved Ukip of its raison d'être.

He writes: "Ukip might not have managed to win many seats in Parliament, but in a way we are the most successful political party in Britain ever. We have achieved what we were established to do – and in doing so we have changed the course of our country's history for the better. Make no mistake; we would not be leaving the EU if it was not for Ukip – and for those remarkable people who founded, supported and sustained our party over that period.

"Our party has prevailed thanks to the heroic efforts of Ukip party members and supporters. You ensured we got a referendum. With your street stalls and leafleting, you helped Vote Leave win the referendum. You should all be given medals for what you helped make happen – and face the future with optimism.

"Like many of you, I switched to Ukip because I desperately wanted us to leave the EU. Now we can be certain that that is going to happen, I have decided that I will be leaving Ukip."

Though Ukip could yet recover if Theresa May disappoints anti-immigration voters, that's not a path that the pro-migration Carswell would wish to pursue. He insists that he has no intention of returning to the Conservatives (and will not trigger a new by-election). "I will simply be the Member of Parliament for Clacton, sitting as an independent."

Carswell's erstwhile Conservative colleagues will no doubt delight in reminding him that he was warned.  

George Eaton is political editor of the New Statesman.