The Health and Social Care Committee has published a report on legislative changes proposed by NHS England and NHS Improvement that champion local systems to decide the most appropriate way to manage NHS resources, and to remove barriers to integrated care.

It states that collaboration, rather than competition, is a better way for the NHS and the wider health and care system to respond to today's challenges.

According to the report, competition rules add costs and complexities, without corresponding benefits for patients and taxpayers in return. Choice and competition can help raise standards and encourage innovation, but, as an organising principle, collaboration is a better way to manage the rising demands on health and social care, improve joined up care for patients and deliver better value for taxpayers. However, the NHS should not become a monopoly as this would not be in the best interests of patients.

The Report also recommends that the law should rule out non-statutory providers holding an Integrated Care Provider (ICP) contract. Until the law is changed, the Committee strongly urges that any ICP contract should be held by an NHS body.

Cross-party endorsement of legislative proposals

Dr Sarah Wollaston MP, Chair of the Health and Social Care Committee, said: "The pragmatic proposals we heard throughout this inquiry are broadly welcome. This Report also represents cross-party endorsement of suggested changes, and presents an opportunity to make integration easier, to encourage greater collaboration and reduce some of the burdens from competition rules.

"Nevertheless, the proposals in their current form are NHS-centric – we would like to see greater consideration of the wider system which the NHS seeks to integrate.

"It is clear that there is no appetite for another large-scale, top-down reorganisation of the NHS and within the current hung Parliament any such major change would not pass the House of Commons. Local health providers continue to work to collaborate and integrate care around patients, in spite of current legislative obstacles and these proposed reforms are designed to remove some of the barriers that can get in the way."

Local systems can help to drive improvement 

Responding to the Health and Social Care Committee reportchief executive of NHS Providers, Chris Hopson, said: “Their report helpfully recognises that collaboration within local systems can help to drive improvement and support more integrated services.

"At present and under these new proposals trust boards will remain locally accountable for the quality of the care they deliver. They must continue to have the appropriate powers and freedom to discharge their responsibilities effectively on behalf of local populations and to work in close partnership with colleagues in commissioning, primary care and social care."

He added that the proposals over powers to create new integrated care trusts are also important, and the committee is right to emphasise the importance of local leadership here. These proposed powers must not be used by the national bodies to force through changes.

Patient choice

The report also supports the intention of NHS England and NHS Improvement’s proposals to strengthen patient choice. The evidence the enquiry collected suggests that practical considerations such as geography have a greater influence on the exercise of patient choice than legislation and that what most patients want is good quality care close to their home. Using patient choice as a lever to improve quality may help for some services, particularly planned or elective care, but as an organising principle, it believes that encouraging collaboration between providers is a much better way to provide good-quality care for patients, especially those with multiple long-term conditions.