The hostile opposition towards private involvement in NHS provision is growing ever louder. But politics is getting in the way of policy, and the private sector is not the villain in NHS reform, argues NHS Partners Network director David Worskett.
Hostility towards the role of the independent sector and competition in NHS provision is baffling because so much of it is ill informed. The sector is caricatured as full of profit-hungry opportunists who will destroy the NHS and its values. If the government is to change its NHS reform programme, it must do so on the basis of facts, not myths. The independent sector has a huge amount to offer the NHS and a proud track record of serving patients extremely well.
The allegations that private sector healthcare providers “cherry pick” services are misleading because the independent sector only does what it is allowed to by regulators and commissioners.
The trend at the moment is for primary care trusts to try further to reduce the scope of those so-called cherry-picked contracts, incidentally reducing patient choice at the same time. Will independent providers be accused of even more selective cherry picking when the scope of their contracts has been cut back even further? Moreover, in mental health and end of life care, independent sector providers take on responsibilities at least as challenging as anything done by their NHS counterparts.
The truth is that independent providers would be happy to provide a wider range of services. The UK has independent companies that provide full hospital services in other healthcare systems. The only thing stopping them are the restrictions imposed by the NHS.
Hostility to the application of competition policy is equally ill founded. Competition law exists, fundamentally, to protect consumers – patients. There are plenty of precedents for competition law needing to be adapted to work effectively in other sectors. Once this has been done, history shows that competition has brought consumers real benefits and driven up quality.
One of the myths about the proposed NHS reforms is that Monitor, in its new role as the economic regulator, will promote competition regardless of the consequences. Monitor’s proposed role provides the safeguards to avoid this risk. The regulator’s task will be to manage competition so that key healthcare goals such as the need for cooperation and integration are protected. But we must not lose sight of the fact that competition is a vital weapon in the NHS’s armoury for driving change and improvement.
For providers, the application of EU competition law is already a reality. Commissioners – and the public – should be relieved: having to obey the basic principles of competition law helps ensure that providers cannot engage in self-serving practices that disadvantage their patients.
For commissioners, it is procurement law that matters. The purpose of this is primarily to ensure that taxpayers get the best value for money, through commissioners using best practice in terms of achieving value. What could be more important to the NHS itself and the taxpaying public in times of financial stringency?
Finally, there is alleged “privatisation” of the NHS under the proposed reforms.
It is hard to see how the extension of the foundation trust model, with restrictions on activities and use of assets and its profoundly public sector ethos, can amount to any form of privatisation. Foundation trusts will now have their freedom to develop and innovate increased, potentially even increasing the dominance of public sector providers in the overall NHS. Moreover, under the government’s proposals, a large proportion of services will remain exclusively in NHS hands.
Independent sector providers across all sectors currently provide at most around 5 per cent of NHS care (excluding mental health and GPs). Even in the rather unlikely event of that proportion doubling, a 10 per cent share cannot possibly amount to “privatisation”. Again, the allegation simply doesn’t stand up to informed scrutiny.
The chair of the health select committee, Stephen Dorrell, has commented, rightly, that politics is getting in the way of NHS policy. One might add that flights of fancy seem to have taken the place of facts.
We have to hope the NHS Future Forum and the politicians who will decide what to do in the light of the forum’s report will focus on those major issues rather than the ones that are taking up too much of the debate at present.