‘NHS hospitals can advertise to attract patients’. ‘Anger at plan for private surgeries’. ‘Pledge to battle Virgin NHS plan’. ‘NHS chief reaffirms commitment to private primary care providers’. These are just a handful of newspaper headlines in March – welcome to Labour’s Sicko NHS. Michael Moore’s film (see review FRFI 199) is a warning of what is to come. The wholesale privatisation of health care services is now underway, and with it will inevitably come rationing and a two-tier service. Robert Clough reports.
From 1 April, NHS hospitals will be able to advertise for patients – but so will private hospitals as ‘patient choice’ of hospital treatment extends to include any hospital, public or private, that meets Department of Health standards on quality and price. Meanwhile a new appeals process is being set up to ensure that all health care providers – including private firms – have an equal chance of getting NHS contracts. The move reflects instructions to Primary Care Trusts (PCTs) that they must purchase services such as diagnostic tests and minor operations ‘from the providers who are best placed to deliver’ and that any new or ‘significantly changed’ service of any size must be put out to tender. The appeals panel will of course have ‘private sector expertise’ – in other words, private sector representation.
Following Derbyshire PCT’s decision in 2006 to hand over the running of two GP practices to US health giant UnitedHealth UK, proposals to sell off the running of health care facilities to the private sector are accelerating:
• Camden PCT has also agreed to transfer the running of three GP practices to UnitedHealth UK. Parent UnitedHealth Group is the largest and most profitable health insurance company in the US, insuring over 70 million people;
• In line with government requirements, Camden PCT additionally plans to tender for the supply of out-of-hours GP services when the contract with the present provider, not-for-profit Camidoc, ends on 1 April. Camidoc also supplies this service to four other nearby PCTs;
• Tower Hamlets PCT has agreed to Atos Healthcare taking over the large St Paul practice in the east end of London. Atos is a management and computer consultancy.
• Sheffield PCT wants to establish a large private medical practice in the city; Virgin Healthcare is one of the bidders.
• Birmingham PCT has drawn up plans to pass the management of its primary care services to the ‘independent sector’ – private companies. Bidders are expected to include, once again, Virgin Healthcare;
• Kingston hospital is proposing to hand over its elective surgery centre, opened last autumn, to private sector management and is completing the tendering process.
Virgin Healthcare, just set up last year, is holding presentations all over the country in an effort to gain its first NHS contracts, popping up for instance in Oxford, Sheffield and Liverpool. It believes that by 2050 the market for private health care will be worth the same as the NHS, and not surprisingly wants a slice of the action.
In an effort to soften up GPs for privatisation the government has forced them to agree to work in the evenings and at weekends even if it means closing during other times of the working week. This would be a direct attack on the needs of the elderly and those unable to work. As it is, there is no identifiable benefit to patients since those professionals who work alongside GPs will not be available outside normal working hours. In reality it is an attempt to make salaried work more attractive to new GPs so that private companies can recruit them. To make it even easier for the private sector, the Department of Health plans to change regulations to allow untrained GPs to work in 113 new surgeries being set up under the Equitable Access in Primary Medical Care programme. The only restriction is that one of the GPs in these surgeries be fully trained. Perhaps UnitedHealth knew of this change when it bid for the Camden practices – it was reputed to be proposing to charge the PCT £70 per patient as opposed to the £100 bid by neighbouring practices.
Whilst many have focused on the implication for service quality if GP practices are run for profit, private companies which provide these PCTs will have to be involved in practice-based commissioning, a little-understood policy introduced in 2004. Since their universal establishment five years ago, PCTs have taken over responsibility for purchasing hospital services on behalf of their local population. With Payment by Results this now works on a contractual basis – an essential step if private providers are to be induced to offer hospital services. Practice-based commissioning involves GP practices in the purchase of hospital services by giving them an indicative budget. The PCT continues to manage the money, but the decisions about what hospital care is purchased, and where, is nominally passed into the hands of GPs, usually organised into consortia. Commissioning a patient-led NHS, published in 2005, accelerated the implementation of practice-based commissioning and demanded the involvement of all GP practices by the end of 2006.
As private companies start to take over GP practices so they will have a direct involvement in deciding how and where money is to be spent on hospital care. Furthermore, they will be represented on PCT Boards and Professional Executive Committees. Labour’s plan is to franchise those primary care services for which PCTs presently have responsibility – district nursing, health visiting and so on – leaving PCTs to just do commissioning. A step in this direction is a pilot scheme involving the construction of eight privately-run polyclinics. Now PCTs have received instructions to establish one polyclinic each, regardless of need. There is no doubt that the buildings and the services within them will in future be run by private companies.
Alongside this the NHS has drawn up a list of 14 approved companies to bid for contracts to ‘help’ PCTs spend the £75 billion they have for commissioning health care. The list of course includes UnitedHealth, which Sicko featured prominently for both denying health insurance and then denying payments to those who were insured. The fight against privatisation is on.
FRFI 202 April / May 2008
