Privatisation of the NHS

There was a dire health debate on the Daily Politics show this afternoon, which proved to be another example of how to engender despair at our self aggrandising macho political system. The only woman, Jillian Creasy from the Greens, fought her corner but was allowed no chance to try and change the terms of the debate. What a contrast from some of the local discussions in Sheffield which have brought people together in a genuine effort to bring about service improvement as a partnership.

During the discussion (or rather during the series of interruptions)it became clear that mainstream journalists are willing to take on defenders of the NHS as a public service by arguing that the NHS is not being privatised because no shares are being sold. This has been going on since 2011.

Let's be clear. Shares are not being sold because at the moment there are no shares to be sold but that doesn't mean that they couldn't be. On the provider side Trusts were created by the Tories for the internal market, then made into more independent financial entities by Labour (Foundation Trusts)- which could easily become more independent still (those that are not bogged down in bankrupting PFI agreements at least); while the proposals in the Five Year Forward View can easily lead to the creation of local health corporations.

But shareholding isn't the point. Creeping privatisation is the normalisation of commercial and market relationships in the NHS by enforcing competitive tendering and allowing the private sector 'a level playing field'. This changes the value base of the NHS and also leads to its resources being fed into the pockets of private providers and shareholders. (That's the theory - though in practice private contracts are proving more loss making than profitable at the moment.) For a patient it means that her or his service is dependent on decisions made by commercial providers for commercial reasons which do not have the patient's interest as their prime objective. If there are issues or gaps, resolution will depend not on what is best for the patient but what is in the contract. And of course there is no security because a private provider can simply walk away from provision leaving the NHS to pick up the pieces.

Both Andrew Neill and Jeremy Hunt argued that the increase in contracts to the private sector was relatively small compared to what Labour had started but Andy Burnham was right to reply that it is not so much the value of the contracts being given that needs to be taken into account (a few are huge but the most expensive NHS services remain in house) but their number - leading to a huge increase in the number of occasions that a patient will encounter private providers with no accountability to her or him, and also to the fragmentation of services.

The overall scenario is best put by James Meek in his book Private Island (Verso 2014.)The NHS 'hasn't been privatised and the political parties vie with each other to show that it's safest in their hands. Yet it has been commercialised and repeatedly reorganised, with competition introduced, in such a way as to create a kind of shadowing of an as-yet-unrealised private health insurance system.' (p19) and 'The more closely you look at what has happened over the last twenty-five years, the more clearly you can see a consistent programme of commercialising the NHS which is independent of party political platforms.'(p163). See also his recent articles .

There is little evidence that private contracting is working. Apart from the well-known failure of Circle in the acute sector at Hinchingbrooke and the chaos engendered by some of the contracts elsewhere ( Muscoloskeletal services in Bedfor, Dermatology in Nottingham) a study just published in the Journal of the Royal Society of Medicine has found that alternative providers of primary care, including private companies (such as Virgin) and voluntary organisations, do not perform as well as traditional GP practices. Among the differences between types of practices, alternative providers had worse results for patients’ diabetes control, higher hospital admission rates for chronic conditions, and lower overall patient satisfaction. See also various press reports including this one

We may be able to guess the stance of the next government by its decision about the almost completed privatisation of primary care support services (the backroom services for GPs, dentists etc). This is the one for which Lockheed Martin was not shortlisted but the three leading bidders are all private sector. NHS England has already announced the impending closure of more than 9 offices with something like 348 redundancies (about half voluntary). The result of the tendering process is not due to be announced until after the election but will need to be one of the first operational decisions permitted or refused by the new Secretary of State.

There is also the impending privatisation of cancer care at Stafford. Protestors will be marching across Staffordshire during the May Day weekend. Join them if you can.
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