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Review the operation of the NHS internal market

Last updated: 08:44am 17 May 2019

So we will review the operation of the internal market and, in time for the start of the 2018 financial year, we will make non-legislative changes to remove barriers to the integration of care.

Conservative Party Manifesto 2017, p.67

Our verdict

The NHS internal market was introduced by the National Health Service and Community Care Act in 1990. It sought to improve patient care, via competition, by separating care providers (hospitals) and care purchasers (health authorities, named as NHS Trusts). However, opinions changed as bureaucracy was seen to inhibit care.

The 2017 manifesto acknowledged that the internal market “can fail to act in the interests of patients and creates costly bureaucracy”. In light of that, this policy promises to review the way the NHS internal market operates.

The shift in strategic thinking about health provision in recent years has been away from the traditional internal market model of competitive autonomous providers and towards a more collaborative approach, as evidenced by the NHS Five Year Forward View, published in 2014, and more recent thinking outlined, for example, in a 2018 report by the Health and Social Care Committee. The concept of “integrated care” has risen to prominence.

Under this government, the clearest evidence of action to fulfil this pledge has been the publication, in January 2019, of the NHS Long Term Plan, a comprehensive strategy addressing the future of the NHS. A significant element of the Long Term Plan is the roll-out of Integrated Care Systems (ICSs), with the aim of “[bringing] together local organisations to redesign care and improve population health”.

The planning and preparation of the NHS Long Term Plan was a huge undertaking, part of which involved reviewing the operation of the internal market. The government, in the form of the Department of Health and Social Care (DHSC), provides strategic leadership for the NHS and can therefore take credit for the publication of the Long Term Plan. We’re marking this policy as ‘done’.

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