The Academy of Medical Royal Colleges has criticised the government for planning to privatise large sections of the NHS by stealth – in breach of previous promises to doctors to limit the role of the private sector.
Two weeks ago, the Department of Health released regulations that open up the NHS in England to competition on an unprecedented scale. They have started their 40-day journey to becoming law.
The regulations appear to contradict the political assurances given during the turbulent passage through Parliament of the Health and Social Care Act 2012.
In a leaked letter, academy chairman, Professor Terence Stephenson, says that unless the regulations are amended, healthcare will be disrupted and hospital services damaged as a result of time-consuming, disruptive and unnecessary tendering processes.
He says the regulations are “at odds” with reassurances given last year to the colleges, which had warned that “unnecessary competition [would] destabilise complex, interconnected local health economies, in particular hospitals, potentially having adverse effects on patient services”.
Stephenson said in a letter to minister Lord Howe, but leaked to The Observer, that the new regulations “appear to potentially undermine these commitments” and seeks swift reassurance that changes will be made so that the academy’s “considerable concern” is addressed once and for all.
Health professionals have reacted with dismay to the release of the regulations, with over 1,000 doctors and nurses signing a critical letter to the Telegraph.
The profession fears that the new rules will oblige GP groups to put almost all services out to tender rather than limiting tendering to areas in which the profession accepts competition would bring benefits.
The Academy’s intervention is a significant step for the non-political body and suggests that doctors are on collision course with the government yet again.
In 2011, David Cameron ordered a “pause” to the passage of Andrew Lansley’s NHS bill, to “listen, reflect and improve” the modernisation plans, after complaints from the medical profession.
However, from 1 April 2013 commissioners will be required to advertise new contracts, then judge the bids received based on published criteria. The new regulations effectively close down the possibility of awarding a contract without competition, saying that this can only occur in very exceptional circumstances (namely emergency situations or when no other provider is capable of providing the same services).
They also pull arrangements between NHS bodies into the new competition regime. This appears totally contrary to former health secretary Andrew Lansley’s assurances to Clinical Commissioning Groups this time last year.
The new regulations also grant Monitor sweeping statutory powers as a regulator to intervene and enforce competition. Monitor will be able to decide when commissioners have breached competition regulations, and have the authority to set aside contracts, stop arrangements that they deem flawed and to impose competitive tendering and the offer of Any Qualified Provider. During the Bill’s passage, Monitor’s role as regulator changed from one of ‘promoting competition’ to instead ‘preventing anti-competitive behaviour’, but as some suspected, this is a distinction without a difference.
Lord Howe, under heavy pressure to perform a U-turn, has denied that the regulations will open the way for mass privatisation but has agreed to listen to the concerns of critics in Parliament and those within the profession. In a letter circulated to colleagues last week, Howe said the regulations “would not oblige commissioners to create the conditions for new markets to develop where they considered this unnecessary. For example, commissioners would not be obliged to fragment services to enable providers to compete or stimulate market entry.”
Campaigners are running a petition calling for greater scrutiny of the regulations.
Read a feature on the regulations.