The Impact of Private Providers and Competition on our NHS
Below is a transcript of the speech given by Dr Kailash Chand OBE at our NHS event in Manchester.
In February 2012, the battle over the Government’s proposed reorganisation was reaching its peak.
There were claims and counter-claims about what it would all mean.
Now, three years on, it’s time to assess what has happened in the three years since and the overall state of the NHS today as we head towards a General Election which will determine its future.
My conclusion is this: the NHS has never been in a more dangerous position than it is right now. A reorganisation which knocked the NHS to the floor, depleted its reserves, has been followed by a brutal campaign of running it down.
Cameron’s reorganisation has corroded the N in NHS. The Act was a Trojan horse for competition and privatisation.
1. How much of our NHS has been privatised?
£20bn of contracts have been offered to the Private Sector. Three separate studies showed that the Private Sector were winning 33%, 56% or 70% of the contracts that they bid for, depending on which report you place the most emphasis on. The biggest contracts include a £450m Community Health contract awarded to Virgin Care in Surrey, as well as a £140m Children’s Services contract awarded to Virgin in Devon
2. Who can bid for NHS services? How much of our future NHS will be given to the private sector?
Under AQP anyone is allowed to bid, with no regard to their previous expertise. This has led to outsourcing giants with no previous experience in health winning contracts. Andrew Lansley & Jeremy Hunt forced each PCT, and then CCG to offer at least 3 parts of their community health services to the Private Sector. This led to 912 community health contracts being tendered, of which private health won 2/3s. Under recent regulations introduced to the House of Commons on the 4th February, the Health Secretary is insisting that every significant part of future NHS services commissioned be offered to the Private Sector
3. Can we fight this?
Local campaigns have been very successful at halting further privatisation. UNITE performed an admirable role in preventing the tender of George Eliot Hospital going ahead. Equally, a campaign in Cambridgeshire helped ensure Virgin was not chosen for a £900m contract there. Although we must be vigilant. The NHS offered a better value bid for NHS Stroke Services in Stoke, and the contract was still handed to a private provider. When NHS York beat a private provider to a contract, the private firm took them to a tribunal arguing that the NHS was adopting predatory pricing by not aiming to profit from NHS contracts.
4. Are Private Providers accountable when they fail?
Of great concern has been the recent ability of Private Health Firms to walk away when they contracts are not making as much profit or going as well as they had hoped. Care UK walked out of a GP Surgeries contract in the North East. Serco walked away from a £140m community health contract in Suffolk, and most recently, Circle Healthcare walked out on a £1bn contract to run Hinchingbrooke Hospital. On all 3 occasions, the private provider was able to walk away. This puts patients at risk as gaps open up in the services provided.
5. Can we be sure that there are no conflicts of interest in this new type of commissioning?
What is also of great concern is the closeness of some private health firms to political parties, most notably the Tory Party. It is possible to trace 744 donations since 2001 from Private Health to the Tory Party totalling more than £20million. Voters are right to be concerned when some of those very firms donating then win Private Health Contracts. In total, £2.2bn of NHS contracts were directly awarded to firms who have donor links to the Tory Party.
6. How transparent are private health firms?
What also gives Private Health unfair advantage over the NHS is their exemption from compliance with the Freedom of Information Act. Voters should have a legal right to see how their own money is spent. A lot of business models from the private health sector that are winning contracts contain secret clauses in them to cut the workforce by 20%, but whenever the documents are released to the public these points are redacted on the grounds of commercial confidentiality
7. How does commissioning of services now work and why should we be worried about changes?
Another point of great concern has been the deterioration of Commissioning Support Units. In April 2013, thousands of experts in commissioning services lost their jobs. They were public servants who possessed a deep knowledge of the capabilities of the NHS. Recently, it was announced that 3 US Corporate Giants, including Capita, have won contracts of a value of £3-5bn to take over commissioning services. How confident can we be that these US Corporate Giants will look favourably on the NHS when it is competing with the private sector to win contracts?
8. But I thought Cameron said that GPs were in charge of his new reforms?
The government told us that GPs would be in charge of commissioning and that this would take place through CCGs. In the initial pathfinder/shadow CCGs GPs made up 56% of the staff on the groups but that has since fallen to 33%. Let me be clear about this. 99% of GPs have 0% of a say in how NHS Services are commissioned. This was a con.
9. What is the actual problem with the Private Sector running our health system?
There are 3 key problems with private health firms running our NHS. First, there is no room in the budget for the profit they wish to make. Virgin say they want to make 8% profit on the NHS services they provide. If the private sector won the £20 of services tendered to them, it would be equivalent of £1.6bn of taxpayers’ money being set aside for dividends to Private Healthcare’s shareholders. Second, private does not mean better care. Every single private health firm has had shortcomings identified by the Care Quality Commission when they inspected their premises. Worries have included poor staffing levels as well as poor and unsafe care for patients. Lastly, private firms reserve the right to restrict treatments. Some private firms who have won musculoskeletal services have restricted an entitlement of sessions to just 6 before asking patients to pay for more sessions. 21 NHS Treatments are no longer free at the point of use in over 100 parts of England.
10. Let me leave you with the words of Michael Sheen
- In 1945, Aneurin Bevan said, “We have been the dreamers. We have been the sufferers. And now we are the builders”. And my god how they built and what they built. Every bit as much a wonder of the world as any architectural marvel or any natural miracle. The National Health Service. A truly monumental vision. The result of true representation, of real advocacy. A symbol of equality, of fairness and of compassion. The nation that swept the post-war government into power was made up of a people that had faced the horrors and hardships of the Second World War. And bound together as one community, they had been sustained and inspired by a feeling of comradeship, and sense of responsibility for their fellow man and woman. Compelled to help those in need and those in hardship.
- In his book ‘In Place of Fear’, Bevan said, “The collective principle asserts that no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means”.
- We do not turn our backs on those facing hard times. We do not abandon them or exploit their weakness. Because they are us. If not now, then at some point and inevitably, they are us. We are not afraid to acknowledge that we can be ailing. That we can find ourselves weak. We do not shy away from that hard truth. We embrace it because in that way, we are always strong. We leave no-one behind. We only say we cross the finish line when the last of us does. Because no-one is alone. And because there is such a thing as society.
- It’s no surprise that people feel disengaged with politics. Never an excuse not to speak up for what you think is right. You must stand up for what you believe. But first of all believe in something. Because there are plenty out there who believe in grabbing as much as they can. They won’t say it. They are too smart for that. No one says they want to get rid of the NHS. Everyone praises it. It’s as powerful a symbol for goodness that anyone has.
- This is beyond party politics. This is about who we want to be as a nation. Too many people have given too much and fought too hard, for us to give away what they achieved and be left with so very little.