comment: Primary care trusts must lead the way in testing private sector

Published: 24/04/2003, Volume II3, No. 5825 Page 15

Last Christmas, an HSJ journalist asked a very senior Richmond House mandarin what had surprised him most about the last 12 months. 'Our increased use of the private sector, ' he replied.

There has been a steady rise in NHS work undertaken by private sector hospitals, but it hardly takes the breath away. It constitutes neither the step change the private sector believes it can deliver, nor the jump in workload the government thinks will be necessary to significantly aid the rush to hit waiting list targets. Our news focus (pages 12-13) shows the NHS still continues to treat the private sector as a pressure release valve, particularly towards the end of the financial year.

There are four main reasons for this. The on-off relationship between the NHS and private providers has created an environment in which workload is hard to plan and, therefore, difficult to resource and costly to provide. Long-term relationships would solve most of these problems. The other reason is the belief that the NHS simply should not provide private healthcare with work.

Anyone delivering healthcare for a profit will be inclined to reduce standards by cutting costs, it is claimed. They will also soak up resources which could be deployed in the NHS, reducing the access for those that cannot afford to pay. The lack of quality is something that Nuffield employee Shelagh Gowing would argue with (My brilliant career, pages 30-31), but once the Commission for Healthcare Audit and Inspection begins to review NHS and private hospitals on the same terms, that argument will be settled.

The final objection is, arguably, an academic one. By most objective measures NHS care is improving - yet still use of private hospitals is increasing: 13 million people pay for healthcare, directly or through insurance schemes. A large proportion of the British public seems to have decided it wants private healthcare to supplement the NHS. Can NHS staff continue to disown the private sector faced with this level of support?

The private sector says it could double the amount of work it does. In an environment in which lack of capacity is constantly bemoaned, the NHS is honour bound to find a way for this claim to be tested. Primary care trusts must be in the vanguard of this attempt to make the NHS/private sector concordat worth more than the paper it is printed on.