Sir Stephen Bubb

Sir Stephen Bubb

Tuesday, 26 March 2013

Lamb, Prevention and Francis/Monitor.




A big day in the health world. Obviously our ACEVO health and social care conference, the launch of the Monitor report on a fair playing field and the Government's response to the Francis report. Not to mention that next week the new national Commissioning Board and CCG structure gets fully into operation.



But at the Royal Mint ACEVO's conference swung into action with a fine speech from Norman Lamb MP. I introduced him as a progressive force and it’s true. He gave us a brilliant speech.



As reported in Third Sector magazine, one of the barriers preventing voluntary sector organisations from playing a larger role in providing NHS services is the "hopelessness of commissioning in many parts of the country"; he said to great applause from assembled delegates.

Commissioning was poor in too many areas.

"It's quite a young science and the skill levels are quite low," he said. "If we're to move to a new system where work is contracted out rather than done centrally, it will work only if the commissioning is good."



Lamb said that too many local authorities procured care services on the basis of who could charge the least for an hour. How true. And how wrong.



"As a result, you get a race to the bottom," he said. "There’s no incentive for providers to help people. It’s in their interest for individuals’ needs to grow so they can get paid for more care. We should be commissioning to improve the lives of people."





He said the traditional way of commissioning services was "professional people making assumptions about what people want or need". Voluntary sector organisations had "pioneered the remarkable idea" of asking people what they needed, he said.

 I much agreed with his comment that the NHS was "like a national religion" that people were reluctant to challenge or change.



"There's a sense that something awful happening in an NHS hospital is better than something awful happening elsewhere," he said.



In introducing Lamb I argued that the third sector had a "central role to play" in meeting the challenges of providing healthcare and wellbeing. I said it’s difficult to imagine how you can tackle the funding challenges, the growing prevalence of long term conditions and the fact that the majority of people in hospital are frail elderly. He picked this up when he said, "I hope the voluntary sector gets involved enthusiastically and optimistically, because you can bring so much to the table."



And Lamb was a good warm up act for the launch of ACEVO's taskforce report on prevention. Chaired by Hugh Taylor, former Perm Secretary at DH.






As Lamb said earlier we must move from repair to prevention. More resources into community support and care and into prevention.



I also stressed to Lamb how we need to implement the conclusions of the Monitor report on a fair playing field. I particularly stressed the need for action on VAT. I said they needed to accept the recommendation on lifting VAT for charities and promised him our support in fighting the Treasury to get this sorted. We have argued this for ages. Will we now make progress ?  



Healthcare charities should be entitled to the same VAT rebate as public sector providers when they bid for NHS contracts, a report from the healthcare regulator Monitor is expected to say tomorrow.



The Fair Playing Field report  makes a wide range of other recommendations aimed at removing obstacles to fair competition between voluntary, private and public providers in the NHS.



Monitor was asked to produce the report a year ago by the government after complaints from a range of  charities like  Sue Ryder or Leonard Cheshire that VAT rules made its services more expensive than NHS rivals.



Under existing tax rules, NHS providers can recover VAT on some non-business supplies that voluntary sector organisations cannot.



There are no estimates for how much a VAT rebate would save but   irrecoverable VAT is typically from between 3 and 5 per cent of a charity’s costs.



Monitor’s review is based on interviews with more than 200 organisations involved with the NHS. ACEVO was closely involved .



Other recommendations are  that commissioners should create smaller contacts and reduce the amount of capital they require bidders to hold. Another is that commissioners must consider social value when assessing bids. 



 I gave evidence to Monitor and took part in several public meetings during the review process. I'm clear that VAT has been a long-running sore in the sector.



If changes to the VAT regime were recommended in the report, the government should implement them swiftly as I told Lamb.



The government mustn’t wimp out or wriggle out. We don’t want weasel words or lengthy consultations.  It should be implemented.




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