Privatisation of health

Pauline Bryan

FOUR YEARS AGO TONY BLAIR ANNOUNCED IN A MAJOR SPEECH ON HEALTH THAT THE GOVERNMENT IS RIGIDLY OPPOSED TO ANY CHANGE IN THE WAY WE FINANCE HEALTH CARE. WE WILL HAVE NO “AMERICANSTYLE” SYSTEMS HERE, HE SAID.

A year ago Labour Party conference delegates cheered as a motion calling for the suspension of any further expansion of private sector care into the NHS was passed overwhelmingly. In moving the motion Dave Prentis opposed an NHS driven not by patient need but by profits and markets.

Unison’s motion was backed by 71.09% to 28.91%. A loyalist motion supporting the government’s health care policy, tabled by Birmingham Hall Green CLP, was voted down by 70.35% to 29.65%.

In February this year Tony Blair welcomed 11 private healthcare providers to the “NHS family” and promising them a huge chunk of the NHS budget. Part of this process is “practice-based commissioning”.

Local primary care trusts in England are able to contract with private providers for GP and other services. Using recent legislation North East Derbyshire Primary Care Trust (PCT) awarded the contract for the provision of GP services to the USA based multinational UnitedHealth Europe, one of the largest providers of “American-style” healthcare in the States. As well as contracting out GP services there will be various other opportunities for private providers to make profits from primary health care for example taking on the whole of the immunisation programme for a local area.

In order to make this attractive the Department of Health has promised “The contract is intended to be light touch and low bureaucracy”. Achievement will be demonstrated “in a single return form to the PCT, to be followed by an annual visit.”

Eventually even the annual visit can be set aside. Private sector companies will no doubt be able to restrict the information that can be made public claiming commercial confidentiality. Compare this to the heavy handed monitoring of public sector provision.

One may think it would be more important to closely monitor private sector arrangement where there are many opportunities for fraud. The campaigning group website ‘Keep Our NHS Public’ shows a long list of fines for “cheating patients out of money” incurred by UnitedHealth Europe’s parent company UnitedHealth Group. The president of UnitedHealth Europe is one Simon Stevens, Tony Blair’s former health policy adviser. He is probably a future contender for honours.

Patricia Hewitt

Pam Smith, a parish councillor challenged the awarding of the contract without public consultation and won on appeal. Not only was she up against the PCT but Patricia Hewitt sent in her own lawyers to defend the contract, claiming it was no different than any previous process of replacing a GP as GPs have traditionally been independent contractors. The lawyers covered up the crucial difference that in the past the GP’s contract was with the Secretary of State, under this contract the GPs would be under contract to the private company. When Pam Smith heard that her appeal had been successful she said “She [Patricia Hewitt] keeps saying patients have a choice; well we’ve made our choice”. The Secretary of State and the PCT argued that it was right to deny local people an opportunity to have their say. And the judge at the original hearing ruled that consulting the public wouldn’t have change the outcome. He obviously had an insight into how NHS consultations generally go.

We may have won this skirmish, but not yet the war. Blair and Hewitt will take as much notice of this legal ruling as they did of the Labour Party conference resolution and the other expressions of concern about this way of running the primary health services. The Royal College of Nurses has expressed its concern that many private companies lack public accountability. Issues of commercial sensitivity and lack of transparency in deciding the future shape of services pose a significant challenge for creating a truly patient-led NHS. The changes were described at their conference as “shoddy and ill-thought out”.

Amicus, not the most radical of trade unions, responded to a consultation by stating “the vast majority of the electorate supports a unified NHS. They don’t support the privatisation of the NHS which will turn into a Californian gold rush for private companies, at the taxpayer’s expense.”

The National Policy Forum consultation on health is now available. It states “at the heart of Labour’s health reforms lies our commitment to give patients more say in how, where and when they are treated. By putting patients in control we are shifting power from providers into the hands of patients”.

The document has made a subtle change to language using the term “independent” sector rather than “private” sector. It asks the question “what are the different criteria that we should use to establish the extent and balance of diverse providers in order to achieve the best care for NHS patients?” We should tell them in no uncertain terms that the question itself is unacceptable as it starts from the assumption that the NHS will be fragmented.

The Welsh Assembly has made it clear that it has no intention of transferring community services out of the NHS, but financial incentives of using off balance sheet accounting may be hard to resist.

In Scotland the strategy is to encourage more engagement with the voluntary sector in the provision of services. As with other health care provision in Scotland the privatisation may come in through the back door so it is essential to be vigilant. The government has decided to make the use of the private sector in health an ideological issue in England, whereas in Scotland the debate is being side stepped and meanwhile privatisation is being introduced by stealth.