Commissioning through competition and cooperation in the English NHS under the Health and Social Care Act 2012: evidence from a qualitative study of four clinical commissioning groups

Abstract

ObjectiveThe Health and Social Care Act 2012 (‘HSCA 2012’) introduced a new, statutory, form of regulation of competition into the National Health Service (NHS), while at the same time recognising that cooperation was necessary. NHS England's policy document, The Five Year Forward View (‘5YFV’) of 2014 placed less emphasis on competition without altering the legislation. We explored how commissioners and providers understand the complex regulatory framework, and how they behave in relation to competition and cooperation.DesignWe carried out detailed case studies in four clinical commissioning groups, using interviews and documentary analysis to explore the commissioners’ and providers’ understanding and experience of competition and cooperation.Setting/participantsWe conducted 42 interviews with senior managers in commissioning organisations and senior managers in NHS and independent provider organisations (acute and community services).ResultsNeither commissioners nor providers fully understand the regulatory regime in respect of competition in the NHS, and have not found that the regulatory authorities have provided adequate guidance. Despite the HSCA 2012 promoting competition, commissioners chose mainly to use collaborative strategies to effect major service reconfigurations, which is endorsed as a suitable approach by providers. Nevertheless, commissioners are using competitive tendering in respect of more peripheral services in order to improve quality of care and value for money.ConclusionsCommissioners regard the use of competition and cooperation as appropriate in the NHS currently, although collaborative strategies appear more helpful in respect of large-scale changes. However, the current regulatory framework contained in the HSCA 2012, particularly since the publication of the 5YFV, is not clear. Better guidance should be issued by the regulatory authorities.

The regulation of competition in the National Health Service (NHS): what difference has the Health and Social Care Act 2012 made?

“…Clearly, there are many factors in addition to the regulation of competition that have changed between the two periods being examined such as the landscape of organisations planning and providing services, however, this paper focusses solely on the differences that can be related to the change from sector-specific regulation to a legislative framework. The paper does not discuss the interpretations of actors of HSCA 2012, although this is an important aspect of the impact of HSCA 2012 (see Allen et al ., 2015). The paper argues that the regulation of competition has remained largely an internal matter for the NHS despite the increasing emphasis on the role of competition law and external regulators.…”

Clinical managers' identity at the crossroad of multiple institutional logics in it innovation: The case study of a health care organization in England

“…This is evidenced by an increasing number of medical professionals taking on managerial roles as well as paying attention to costs and resources in the performance of routine tasks (Carvalho, 2012). In addition, the logic of managerialism has driven the introduction of market and competition, which, in England, translates into the commissioning of health services (Allen et al, 2017). The commissioning function that some medical professionals are required to assume is thus part of the logic of managerialism (Martin, Currie, Weaver, Finn, & McDonald, 2017).…”

Partnership and accountability in the era of integrated care: a tale from England

“…In a regulatory and legal context that remains formally governed by expectations of competition and contracting, and where performance is still managed at the organizational rather than the system level, collaboration is a risky endeavour, as system leaders themselves have found. 7 Second, the democratic function of Health and Wellbeing Boards is conspicuous by its absence in many emergent integrated care systems. Although the composition of Boards varies, 8 all must include among their members elected councillors, as well as senior officials from both the local NHS and local government.…”

“…In a regulatory and legal context that remains formally governed by expectations of competition and contracting, and where performance is still managed at the organizational rather than the system level, collaboration is a risky endeavour, as system leaders themselves have found. 7…”