Involving overseas healthcare operators needs careful handling

Published: 27/06/2002, Volume II2, No. 5811 Page 21

The accelerator is being pushed to the floor on the government's plans to exploit the expertise and capacity of overseas healthcare organisations for the benefit of NHS patients. Overseas clinical teams working in NHS units will provide the first wave, then will come rapidly refurbished and/or temporary centres run by independent operators, mainly in the South East and dedicated to orthopaedics and cataract operations. US healthcare management organisations are likely to be involved at a primary care level, helping develop systems to manage chronic conditions.

That much we pretty well knew, but what is significant about the Growing Capacity plan (news, page 5) is its description of the 'international establishment programme to co-ordinate the development of a managed market in this new sector of healthcare provision'. The aim is clearly to embed these independent operators in the fabric of the NHS, to give them a 'permanent' role, as health secretary Alan Milburn has declared.

The Department of Health is 'working urgently' on how independent providers might undertake 'procedures that are more difficult to define than cataracts and orthopaedic work' and the basis for contracts that 'include a need for substantial capital investment'.

Primary care trusts and strategic health authorities are to be given incentives 'to manage the challenge of developing a pluralist/diverse health delivery system', while, for the first time, the DoH commits itself to 2005-06 deadline for funding hospital treatment on a 'price per case' basis - a vital step if independent suppliers are to 'operate and compete within the same commissioning framework as other providers of NHS care'.

The short-term proposals have merit in dealing with localised demand hotspots, but the plans for the medium term are more problematic. This is a policy being developed on the hoof - albeit by intelligent, committed and politically astute people. The speed of development means it has been impossible to build a consensus around the policy - and there has been little attempt to. Indeed, calling the document 'a prospectus', with that word's association with share offers and privatisation, appears almost wilfuly provocative.

Consensus is a cornerstone of the NHS plan and why it has been so widely embraced.

The government must be careful not to treat lightly the trust it has built up - especially over a policy which, even it succeeds, is unlikely to affect most patients for many years.