BMJ: the end of England's NHS?

A consultant radiologist looks at some of practical dangers of the Coalition's privatisation of NHS services, described by the BMJ as potentially the end of England's NHS, and urges peers to vote against the privatisation regulations.

Richard Fitzgerald
16 April 2013

Parliamentarians heading back to Westminster after their break, may wish to reflect on the Easter edition of the British Medical Journal, whose cover article was entitled “The end of England’s NHS?”.

In it, British Medical Journal editor Fiona Godlee writes that the April 24th House of Lords vote on the NHS competition regulations is a "once in a lifetime opportunity to influence the future of England's NHS. We must seize it on behalf of present and future generations".

As the battle to defeat these regulations in parliament draws close, the BMJ’s concerns are being echoed in just about every quarter of the medical profession. My own Royal College, the Royal College of Radiologists, has written to health minister Lord Howe, saying that under the regulations:

"…commissioners still do not appear to be entirely free to decide whether or not to expose services to competition. Despite the revisions, commissioners will still be required to show that there is only one capable provider in order to avoid having to put a service out to tender.”

Ministers have issued warm words, nudged Monitor to do the same, and promised that guidance will help. But such reassurances carry no legal weight whatsoever. As the College says, “Given that the Regulations will have statutory force we are firmly of the view that the Regulations must be clear as to their intent and thus in what the actual words convey...integration of healthcare services should not be overriden by competition."  In other words, Local Clinical Commissioning Groups must be allowed the unambiguous legal right to award a contract for a service to a local NHS hospital without tender if that is in the best interests of patients, integrated healthcare, training, and efficiency.

It is folly to force the English NHS into competition for the sake of competition, irrespective of the effect on patients, best use of resources and long term sustainability of the NHS.

Firstly, it is not the ‘invisible hand’ of the market that will magically allocate resources. Competitive markets introduce hugely expensive and cumbersome transaction costs, sucking precious resources from the NHS just when it should be focusing instead on the rising healthcare needs of an aging population.

It is a process that will favour the private sector – with their teams of specialists preparing their takeover bids – and disadvantage the NHS, whose bids will be prepared by overworked clinical staff in their evenings, weekends and annual leave, distracting them from the needs of patients, to worry about the whims of the private sector.

The private sector will also cherry pick the low complexity work which currently cross-subsidises 24/7 delivery, complex care, training, service development, and research. The resultant loss of funding by NHS hospitals will have adverse consequences for patients.

Woefully crude tariffs don’t reflect the variance in complexity from one patient to the next. It can take up to four times longer to interpret the ­­­CT or MRI scan of one patient, than of another’s with a simpler medical history, due to the need to compare the scan with previous images, and conduct further measurements and research. 

As I have written in the forthcoming May issue of Clinical Radiology, competition for Radiology contracts could lead to ‘race to the bottom’ bids, which in turn would encourage faster, possibly excessive reporting speeds by some Radiologists. The fragmentation of Radiology provision could deprive teleradiologists in some companies of previous scans for comparison. Such problems can compromise the accuracy of interpretation, and /or lead to recommendations of unnecessary and costly further scans and tests.

As Professor Clare Gerada, Chair RCGP Council, has said, these new NHS competition regulations, if passed by Parliament, allow for "the wholesale dismantling of the NHS”.

The regulations are unwanted by the medical profession and will be bad for patients. There could even be consequences for the Union, as the Scottish administration has remained strongly committed to a publicly owned NHS, and is likely to highlight the consequences of NHS privatisation in next year’s Scottish Independence Referendum.

I urge all Peers to vote down the English NHS competition regulations on April 24th.

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