The Government keeps insisting that it is not privatising the NHS – but it’s not for want of trying.
A new exhibition ‘How come we didn’t know?’ by London photographer Marion Macalpine, opening on November 8 at Theatre Delicatessen on the Moor, charts the extent to which NHS services have been contracted out, especially in the South of England.
At 7pm (same day, same venue) the Festival of Debate hosts a reading of Laurence Peacock’s play ‘A Duty of Care’ on Labour’s changes to the NHS in 2003 – which paved the way for the later Tory NHS reorganisation.
Although recent years are littered with contract failures, almost half of all new service contracts in the NHS still go to private companies.
At least 7.6 per cent of the NHS is currently outsourced and perhaps the worst thing is how often profit-making companies operate under the NHS logo.
For instance how many people know that the Sheffield GP walk-in centre is run by First Medical Group?
How many people accept what look like NHS referrals only to find the provider is a private one?
Why does this matter? Because outsourcing erodes the NHS as a public service; is damaging for staff; fragments services; and most of all because it places them under the control of owners and managers whose reference points are contracts and cost control, not any broader commitment to the public’s health.
If something is not in the contract, out of the window it goes and patients find it even more difficult to secure redress.
Where there is trouble, performance data has been manipulated or contractors have just walked away, leaving the NHS to try and make it up to patients just as happened at Westfield Health Centre this year when Danum withdrew or, further afield, at Hinchingbrooke Hospital.
Of course cost controls are not entirely due to the search for profit. Government cuts to local authority budgets are far too large to be made up by the two per cent council tax social care precept whatever the government likes to pretend.
The Care Quality Commission warned last month that the social care market was at a tipping point.
Between November 2015 and May 2016 32 councils had care home contracts handed back – 59 had home care contracts cancelled.
Recently a reverse trend has begun as public authorities begin to bring services back in house – ranging from social care to street cleaning. The resulting services are reported to be cheaper and more efficient.
Within the NHS the drive for competition is less overt than it was. But that doesn’t mean it isn’t still happening or that the likes of Virgin Healthcare will not sue the NHS if they feel excluded.
In Sheffield, where closer partnership working is developing, major privatisations are not yet on the horizon.
But the still unpublished Sustainability and Transformation Plan to move more services to the community under a cost limit set by NHS England below the level of need will depend on cuts and it risks more publicly provided services disappearing as they can more easily be bundled up into parcels which companies can bid for more cheaply than the NHS can.
Without safeguards (including social value commissioning) NHS community services could easily go the way of social care, especially if they are subcontracted out of public view through one of the local trusts.
There may be instances where local or niche services can be more flexibly provided by third sector or similar organisations (proposals for patient transport are being considered) but open tender should not be the default position. Longer term, the Accountable Care Organisation model being pushed through the STPs sets up a structure which could more easily be absorbed in a later private sector takeover.
n On November 22 Sheffield Save our NHS and the Festival of Debate will host an open debate on the future of the NHS with a panel of local NHS leaders, academics and campaigners. Visit www.festivalofdebate.com/november-2016.html and www.sheffieldsaveournhs.co.uk for details of all events.