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High sounding words but privatisation marches on

There’s a lot of half promises being offered at the moment … but with it being political conference season perhaps that is to be expected.

First up, Labour’s Andy Burnham vowed to repeal the coalition’s Health Act, well, sort of. He would put the national back into the NHS (whatever that means), and focus on integration not fragmentation.

No mention of doing away with the market, however, nor getting rid of the new structures.

I guess this is to be expected seeing as much of the current privatisation agenda was initiated by the previous Labour government – a fact not lost on health secretary Jeremy Hunt who said today: “First rule of opposition Andy: criticise what the new lot do, not what you did yourself.”

Behind all the hyperbole, the realities of the Health Act are starting to be felt. There’s been a massive tendering out of community services, and the cap on foundation trusts’ ability to raise funds privately has been lifted – opening the door to new levels of competition in the NHS.

Jeremy Hunt skirted around the ‘c’ word in his first major speech as health secretary. “Nye Bevan’s vision wasn’t about monopoly provision. It was about universal provision. And to deliver it we must understand the difference between the two,” was about all he said on the subject.

Depressingly, a key check to rampant privatisation proposed by the NHS Future Forum looks to have been discarded by the government. ‘Cherry picking’ was a sticking point to the progress of the Health Bill, and its passage smoothed when the Forum said “a suite of additional safeguards should be introduced”.

The government said it would be “undertaking a piece of work with the royal colleges to identify the procedures most at risk of cherry picking and prioritising work on payment by results to ensure that fair prices are set for these procedures from 2013-14 onwards”. It was hoped that private providers would be paid less for easier cases.

However, a letter sent to NHS managers on plans on 20 September, about the payment by results system for 2013-14, makes clear there will not be further changes to the tariff to address the issue. An annex to the letter, from NHS deputy chief executive David Flory, contains a section called “cherry picking”. It says: “The government’s response to the NHS Future Forum report included a commitment to tackle the ‘cherry picking’ of patients. Having consulted with our [payment by results] advisory groups, we do not plan to tackle this issue through changes to tariff structure. We will instead look to strengthen guidance, with the possibility of including a list of procedures that appear to be most prone to ‘cherry picking’.”

The original commitment was prompted by fears that increased competition would destabilise NHS hospitals by allowing private providers to treat the most profitable patient cases. Will guidance alone level up the playing field? I’ll let you make your own mind up about that one.

Don’t get me wrong. I’m not blaming the private providers – indeed I’m not against the use of the private sector under certain circumstances. They’re not snatching these cherries, they’re being offered them by commissioners desperate to reduce costs.

What I sense, however, is a rush to privatise by a government that wants to make it harder for others to unpick it after the next election should they lose. And rushes never lead to good implementation.

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3 Responses to “High sounding words but privatisation marches on”

  1. Mark KM says:

    Privatisation inevitably means decreased pay for the workers to fund the profits of the private companies. Once GPs have cashed in on their practice/ goodwill their salaries will plummet and many will retire. Medicine will become a mediocre profession but will still probably attract enough idealists to keep going. Bring on retirement!!

  2. Bob Bury says:

    In radiology, we have for a long time been in the position of ‘selling’ our services to neighbouring trusts and primary care. Successive governments have set tariffs which, especially for the more expensive interventional procedures, fail to even cover the costs of the consumables. Then they wonder why radiology departments are so ‘expensive’.

    What’s the betting that tariffs for private providers will be set at more realistic levels? If they really think that privatisation will reduce costs, they are in for a rude awakening.

  3. Once was a soldier says:

    Rearranging deck chairs on the Titanic anyone?!
    Privatisation WILL work for the Government if they do it right.
    First allow a Consortium to run a region (FT’s are dead anyhow and too expensive). Then make private practice untenable in its current format – anyone hearing BUPA whining at this moment? Follow the railways model of selling off a national asset such that a private consortium runs the hospitals – and gets given all the NHS hospitals as a perk to reduce the apparent costs of PFI’s (as they are a bit of an albatross around HMG’s neck) = Network Rail.
    Then get the private insurers (who can run healthcare more financially efficiently than their NHS equivalents) to form the consortia that will deliver the healthcare = First Group/Virgin Rail. Now that would only be attractive to the private sector when they control the costs as the income is fixed by the NHS Tariff and outgoings in the form of the buildings rent are also fixed.
    The NHS pension would have to be reduced to an equivalent private pension – why are we now paying more for the same this year? Thus consortium take all the responsibility off HMG for the NHS whilst HMG retains all the kudos for still providing an “NHS” free at point of service to the customer.
    Simples really.
    Obviously all NHS workers salaries will go down as will benefits including pensions – feel free to move to another region (which will be doing the same) or leave to private practice (which will effectively be owned by the same people). The country will then have the healthcare service it deserves but definitely not the one it needs.

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