Sunday, 22 November 2015

Privatisation threat to NHS grows.

The Tory government has pushed the NHS into a deficit crisis and sewn the seeds of its destruction. Am I being melodramatic? Possibly, but let's consider what has been happening in the NHS over the last five years.

The NHS is under threat not simply from underfunding and deficits but also from a growing privatisation of its services. Figures released last year  by the BMA showed the extent of creeping privatisation in the NHS under the Health and Social Care Act 2012, and it is set to get worse.

The investigation by the BMA found that a third of NHS contracts have been awarded to private sector providers since the Health and Social Care Act came into force.

The BMA council chair, Dr Mark Porter, said at the time:

“These figures show the extent of creeping privatisation in the NHS since the Health and Social Care Act was introduced. The Government flatly denied the Act would lead to more privatisation, but it has done exactly that.

"Enforcing competition in the NHS has not only led to services being fragmented, making the delivery of high-quality, joined-up care more difficult, but it has also diverted vital funding away from front-line services to costly, complicated tendering processes.

"What's worse is that there isn't even a level playing field as private firms often have an unfair advantage over smaller, less well-resourced competitors, especially those from the NHS and social enterprises. To undo this damage we need an honest and frank debate about how we can put right what has gone wrong without the need for another unnecessary and costly top-down reorganisation.”

Outsourcing is a specific intent of this government. It isn't simply a means to better health care. It is an ideological objective in itself.  As more funding is diverted to outsourced companies, so less is available for in-house provision. It is an asset-stripping by stealth.  Once it is gone, it is gone. The less able in-house provision becomes the more the need for outsourcing to meet growing and unmet demand for services.

We might think this outsourcing doesn't matter.  If the services remain free at the point of use, does it matter who provides it? It is also argued that private companies will introduce efficiency and improve care. But we should remember the nature of a market - the distribution of goods through price. It is the very antithesis of the promise on which the NHS works, which is to provide service free at the point of need.

With increasing waiting times and an NHS starved of funding we are already seeing NHS trusts rationing treatment.  With increased private provision within the NHS, such rationing will produce a two-tiered system with those who can afford to pay jumping the queue for treatment.

It is often pointed out that outsourcing didn't start with the 2012 Act. The last Labour government used private provision to 'extend choice'. It was an integral part of Blair/Brown approach to NHS reform. So what's new?

Agreement on the extent of private provision is difficult to find.  The government insists that no more than 6% of the NHS budget goes on private provision. Others disagree.  A key question is whether it is increasing and by how much.  It is the direction of travel that is the problem, and that direction suggests an ever increasing slice put in the hands of private companies.

Earlier this year the NHS Support Federation campaign group showed that private firms had won £3.54bn of £9.628bn worth of deals awarded in England in 2014 – a win rate of 36.8%. A Labour freedom of information request revealed that private firms have been winning 40% of contracts commissioning groups have put out to tender, worth a total of £2.3bn, only slightly fewer than the 41% awarded to NHS bodies. 

Figures from the Department of Health suggest some £10 billion of the total NHS budget of £113 billion is spent on care from non-NHS providers (not including dentistry, medicines or general practice).

Figures gathered by Unite show that in just three years £7 billion of new NHS contracts have flooded the private health care market – a figure set to soar to £20 billion over the next few years. But it is the hard reality beneath the figures that shows the growth of private provision.

Virgin Care runs more than 100 services across the country, including sexual health services in Oldham, a £120 million contract to run Devon children's integrated health and social care community services, and a £500 million contract to run community health services in Surrey. They also run 358 GP practices. 

Serco has won a £140 million contract to run community healthcare in Suffolk and a £32 million contract to run out-of-hours GP services in Cornwall.  Specsavers - the optometrists and eye wear specialists - has bagged more than 30 NHS contracts to supply hearing aids and community audiology services on high streets across the country. It is one of several private firms approved to provide NHS services under the government's 'any qualified provider' scheme.
Creeping privatisation isn't the only threat. Mr Cameron is determined to put his full weight behind the Transatlantic Trade and Investment Partnership (TTIP), a comprehensive free trade agreement currently under negotiation by officials of the European Union and USA.

The aim of TTIP is to create new markets in Europe for transnational corporations. It will open up all public services, including the NHS, to competition from transnational corporations with the likely result of a further wave of privatisations. TTIP works on the basis that all services are open to privatisation unless they are specifically exempt.  Prime Minister  David Cameron has refused to say that the NHS will be exempt. That refusal speaks volumes. 

With more Trusts in deficit and a further financial squeeze we can expect a greater push from government for services to be provided by the private sector.  The scavengers of private equity are circling our underfunded NHS.

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