Look who's after the NHS's first billion pound privatisation

All the big beasts of NHS privatisation are hoping to get their hands on older people's NHS services - though some are employing more innovative methods than others.

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Caroline Molloy
9 September 2013

Yet more evidence of the scale of potential NHS privatisation emerged today as Cambridgeshire health bosses announced the ten groups being invited to submit bids for the largest single NHS outsourcing to date.

Of the invited bidders only three are wholly NHS Foundation Trusts.

Also hoping to get their hands on the £1billion contract to supply all older people’s health and social care provision in the area, are all of the UK private healthcare giants - Care UK, Capita, Circle, Interserve, Serco, Virgin Care, and United Health.

All these companies have seen their fair share of controversy in their outsourcing ventures of late. Of particular note is United Health’s foray back into NHS outsourcing after it abruptly ended its venture into taking over GP surgeries - a move that resulted in a large and popular surgery in Camden being closed down.

Serco and Virgin have applied to take over all the services - currently run by NHS Trusts - themselves. Interserve, Capita and Circle, are applying ‘in partnership with’ NHS Trusts. Meanwhile United Health has hedged their bets by submitting both a standalone expression of interest, and one in partnership with Care UK and other NHS Trusts.

Other bidders include four Foundation Trusts and a “Community Interest Company”.

But as Mark Porter, chair of the British Medical Association, commented when the tendering was announced:

 "The BMA remains concerned that large non-NHS providers, such as those organisations apparently interested in the older people's care contract in Cambridgeshire and Peterborough, could have an unfair advantage during the tendering process over smaller, less well-resourced competitors, especially those from the NHS.”

The way things pan out in the East of England - Lansley's stamping ground and long a test-bed for privatisation - could be an indicator of what is to come for the rest of the NHS. Whilst health and social care integration appears to be attracting cross-party consensus, merging of health and social care into these huge contracts may make it more difficult for the NHS to argue it is the ‘only capable provider’.  Unless this test is passed, local health bosses have little choice but to offer services up to the private sector, under the hugely controversial Section 75 regulations of the Health and Social Care Act.

Also giving a clear advantage to private companies who may lack healthcare experience is the use of a ‘prime contractor’ model where there is a lead contractor and lots of sub-contractors. The ‘prime contractor’ model is one that the NHS’s ‘Head of Commissioning’ Bob Ricketts is keen to promote, saying last month “We need to get to a tipping point where we’ve got enough CCGs doing lead provider contracts at scale.”

The sight of private companies teaming up so determinedly with NHS providers will also raise concerns. Last year a report co-ordinated by private consultants Cambridge Health Network (an offshoot of McKinsey) recommended that such a 'partnership' approach could be used to overcome resistance to private sector takeovers. Sir William Wells, who convened the review, suggested in the Guardian that the word privatisation should be ‘banned’ and replaced with the more helpful word ‘partnership’.

The announcement comes hot on the heels of last week’s report by the NHS Support Federation, showing that 20 out of 24 recently advertised NHS contracts were going to private bodies, not to the NHS.

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