Speaking at the King's Fund on 17 September 2009, Secretary of State for Health Andy Burnham said:
“With quality at its core, I think the NHS can finally move beyond the polarising debates of the last decade over private or public sector provision. Let me begin with where I stand on this debate, and that is that the NHS is our preferred provider. But it is the important job of the commissioner to test whether these services provide best value and real quality.
Where a provider is not delivering quality – and the new accountability information will more readily demonstrate that – we will set out a clearer process that will provide an opportunity for existing providers to improve before opening up to new potential providers. This is fair to all as it means everyone knows where they stand and services stand or fall on the quality they provide”
Following discussion with the Social Partnership Forum, the Department expects all PCTs to follow these principles:
- NHS and existing providers should be engaged at an early stage of service development
- NHS providers should have the opportunity to bid for any opportunities that are developed
- Early and substantial engagement of existing providers is expected
- Early and substantial engagement of staff and their trade union representatives, where applicable, is expected
- Decisions are taken locally, but within clear national guidelines
- Commissioners must demonstrate:
o Fairness and transparency of process
o Clear rationale for decision making
o Needs-driven
o Proportionality (that the commissioner acts proportionately to the size and seriousness of any problem)
- Commissioners are expected to secure best value and quality for patients and taxpayers
- Commissioners are expected to actively monitor the quality of services and to initiate a process with providers if services are not adequate
- The starting point for some scenarios will be the contractual mechanism that currently exists
- Robust oversight and assurance of all the above through:
o PCT Boards
o SHA Assurance
o World Class Commissioning, Transforming Community Services
o Partnership oversight through Regional Social Partnership forums
To illustrate these principles and how they might be developed in practice we have developed six scenarios which set out the processes the Department expect PCTs to follow. These scenarios will inform the development of further guidance from the Department of Health. The Department will engage with the SPF and other stakeholders in the drafting of a successor document to Necessity – Not Nicety; a revised PCT Procurement Guide; and revised Principles and Rules of Co-operation and Competition.
The Secretary of State wrote to Brendan Barber, General Secretary of the TUC, along these lines.
A copy of the Secretary of State's letter is available.
On 15 October 2009, NHS Chief Executive David Nicholson, wrote in similar terms to NHS organisations to explain the concept of 'the NHS as the preferred provider' in advance of the proposed revised guidance.
A copy of David Nicholson's letter is also available.