Private provision of NHS services under threat

Posted on December 2, 2009. Filed under: GP-led health centres, ISTC, News stories, Providers | Tags: , , , |

The Guardian | By Owen Bowcott | 2 December 2009

The government has reignited the political debate about private healthcare companies delivering NHS treatment.

Private companies could find they are not the preferred option for delivering NHS treatments. Photograph: Graham Turner

On a spotless hospital ward pensioners displaying fresh bandages were delighted their knees and hips had just been replaced by the NHS. The surgery had been as good as going private, they declared. Which was what, in fact, it was.

Their confusion was understandable. The sign at the door reads North East London NHS treatment centre. The unit may be based in the same complex as the local NHS King George hospital in Ilford, Essex, and free at the point of delivery, but it is an independent sector treatment centre (ISTC) – a commercial venture, with the surgery provided by private company Care UK.

The mix of private and public healthcare providers within the NHS means that it is hard to disentangle one sector from another. Senior consultants at the ISTC have contracts to work in both the adjoining hospital and the treatment centre; other staff are on loan from the NHS. No private patients are treated. Soon, medical students will be training in Care UK’s facilities.

Blairite triumph

The health market has been presented as a triumph of Blairite politics, enabling internal competition to spur on progress towards improved standards, say its supporters. The health secretary, Andy Burnham, this autumn endorsed that settlement, though, in almost the same breath, he inadvertently helped to destabilise it. “With quality at its core … the NHS can finally move beyond the polarising debates of the last decade over private or public sector provision,” he told health thinktank the King’s Fund – before adding: “Where I stand in this debate … is that the NHS is our preferred provider.”

Labour’s pronouncements since then on patients’ rights, and what is known as the “private patient cap” – the percentage of private treatments that hospitals are permitted to carry out – have set political compasses spinning. While the private/public divide has not been a significant battleground between Labour and the Conservatives in recent years, competitive tendering processes and residual ideological suspicions are now reviving the dormant row.

Burnham’s promise that the NHS should be the “preferred provider” has been interpreted by the private sector as a snub, and by health unions as a signal of Brownite support for traditional Labour values.

Few are clear what “preferred provider” means. The Department of Health attempted unsuccessfully last week to explain by asserting that: “Where existing NHS services are delivering a good standard of care for patients, there is no need to look to the market.” It then qualified the position, explaining that: “Where [NHS] primary care trusts are commissioning new services, then we expect them to engage with a range of potential providers before deciding whether to issue an open tender. These decisions will be made locally, and we will not choose to exclude either NHS or private providers on grounds of ideology – quality and what is best for patients must always come first. This could well mean more private provision, not less.”

Mike Parish, chief executive of Care UK, initially dismissed Burnham’s phrase as merely a political “rebalancing act”. Since then he has become more anxious about its impact. “People have taken that original good intention and presented it as something much more substantive,” he says. “Across primary care trusts there are people who are enthusiasts in terms of reform and others who are uncomfortable with any concept of plurality. This [statement] could take things in a direction that was never intended. There’s a risk of a runaway horse. We are already seeing tenders being issued for the redesign of services with the invitation going exclusively to NHS providers only. It not only constrains the options for PCTs and patients, it’s also certainly anti-competitive. I don’t know if it’s even permissible.”

Parish estimates that 6% of all NHS work is currently carried out by private firms including Spire Healthcare and UnitedHealth UK. Care UK runs a further nine ISTCs, urgent care centres in Luton, and healthcare services in Brixton prison. The company is considering bidding for what would be the first privately run NHS district general hospital at Hinchingbrooke in Huntingdon. Parish fears the “preferred provider” publicity will blight his chances. He is proud of the firm’s very high patient satisfaction rates and its clinical record in the NHS of no cases of MRSA infections.

Landmark battle

Care UK has, however, just lost one landmark battle. Awarded the tender to provide a GP-led health centre by Camden PCT in north London, it had to abandon the contract last month when anti-privatisation campaigners won a judgment in the high court that forced the trust to go back and ask the public whether the area actually needs a GP-led health centre.

The government’s decision to review the private patient cap – while instructing Labour peers to vote down a proposal raising the minimum permissible level of private work to at least 1.5% of treatments in all NHS foundation trusts – has also helped to reignite the issue of private sector involvement in the NHS.

Sue Slipman, director of the NHS Foundation Trust Network, says trusts want to raise the cap, not in order to treat private patients but “because they want to go into joint ventures to bring in money to their hospitals and support expansion of NHS provisions”.

Burnham’s announcement that in future patients will be legally entitled to free private care if not treated by the NHS within 18 weeks has added a further twist to the debate. The British Medical Association is concerned that this will lead to more NHS work going to private providers, with destabilising effects on hard-pressed NHS services.

Back at the North East London treatment centre, the relieved patients were not perturbed about the origins of their free NHS surgery. Instead, they were looking forward to going home quickly.

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