Commons committee backs NHS legislation plans

Committee chair Sarah Wollaston (pictured) said: ‘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.’

But the committee caveated its support with concerns that some proposals were too NHS-centric and increased central control, while more detail was needed in other areas.

One of the key proposals is to repeal section 75 of the Health and Social Care Act covering procurement and tendering rules.

The proposals would allow commissioners to exercise discretion about when to carry out a formal procurement process, subject only to a best value test.

The committee said competition rules had added cost and complexity without corresponding benefits for patients and taxpayer. But it called for more details on the best value test, which must neither be used to exclude non-statutory providers nor be more onerous than current arrangements.

Allowing clinical commissioning groups and providers in integrated care systems to establish joint committees was sensible, but additional proposals should be developed to involve local authorities, the committee said.

It also rejected proposals to give NHS England and NHS Improvement powers to direct foundation trust mergers and to set capital spending limits for these bodies.

The committee did support proposals to allow greater flexibility locally over payment systems, with national prices published as a formula rather than a fixed value.

However, it said more information was needed on how the formula would work. It warned that local flexibility must not result in a race to the bottom, where providers compete on price at the expense of quality. And there was a danger that greater local flexibility could add complexity for large providers.

NHS Confederation chief executive Niall Dickson said he supported the committee’s view that NHS England and NHS Improvement should come together under a single national leadership. ‘[But] we share its concerns that the centre could become too powerful,’ he said. ‘That’s why we are pleased the MPs agree that the centre should not start to direct mergers, acquisitions and the capital spending limits of foundation trusts.’

The King’s Fund also welcomed the report and backed the move towards greater collaboration and integrated care. ‘Like the committee, we support the decision to focus on targeted changes, rather than a wholesale review of the legislation,’ said chief executive Richard Murray.

‘However, it is likely to be a long time before these proposals become law and local systems need to continue their efforts to collaborate more closely within the existing legal framework.’