10.12.14
NHS facing ‘creeping privatisation’
The NHS is facing “creeping privatisation” under the Health and Social Care Act, with a third of contracts awarded to private sector providers since the legislation came into force, research shows.
A study in the British Medical Journal revealed that, between April 2013 and August 2014, non-NHS providers – those from the private and voluntary sectors, or elsewhere in the public sector – have secured 45% of contracts.
The analysis of 3,494 contracts awarded by 182 GP-led clinical commissioning groups (CCGs) during the period revealed that a total of 1,149 contracts (33%) were awarded to private sector providers, 335 contracts (10%) were awarded to voluntary and social enterprise sector providers, while 100 contracts (2%) were awarded to other providers, such as joint ventures or local authorities.
NHS providers, which include hospitals, community and mental health providers and general practice, secured the remaining 1,910 contracts (55%).
Dr Mark Porter, BMA council chair, said: “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.”
When the Act came into force it enshrined principles of ‘choice and competition’ in law by requiring the new CCGs to ensure that NHS and non-NHS providers operated on a ‘level playing field’ in being able to provide NHS services.
GP Dr Steve Kell, co-chair of NHS Clinical Commissioners (NHSCC), told NHE that no CCG has a ‘privatisation’ agenda. The organisation has also called on Monitor and NHS England to support CCGs to navigate the rules by providing more evidence and examples of how CCGs can effectively use existing competition laws.
The Department of Health told NHE that the BMJ study itself makes clear that only 5.5% of contracts were subject to a competitive tender. But BMJ’s FoI request did reveal that of the 195 contracts awarded through competitive tender, private sector providers were most successful at bidding for these contracts, winning 80 contracts (41%). In comparison, NHS providers won 59 contracts (30%), 48 contracts (25%) were won by the voluntary and social enterprise sector, and eight (4%) were won by other types of provider.
Also, within the competitive tendering figures, it was highlighted that 30 (15%) of the contracts were transferred from NHS providers to non-NHS providers. Of these, 13 were transferred to private sector providers, 14 to voluntary sector providers, and three to other types of provider.
“These figures are misleading — official NHS accounts show that use of the private sector amounts to only six pence in every pound the NHS spends, slowing the rate of increase to just one penny since May 2010,” said a DH spokesperson. “Charities, social enterprises and other providers of healthcare play an important role in the NHS, as they have done for many years.”
But Dr Porter added that under the new legislation there isn’t 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” there needs to be an honest and frank debate about how things can be put right without the need for another “unnecessary and costly top-down reorganisation”, he said.
Dr Kell added: “CCGs are regularly faced with difficult decisions regarding the need to tender. It is an issue that NHSCC members have asked for further clarity on with simpler processes for commissioners and providers. As we state in our CCG Manifesto for Change, competition is just one tool in the CCG toolbox and should only be used where it is in the best interest of patients.”
“I am quite clear that no CCG has privatisation agenda. CCGs are independent statutory bodes with a clear focus to improve services for our patients and we are looking at things which are different from traditional NHS hospital based models to ensure we get the best outcomes for our patients and local populations.”
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