In the biggest outsourcing to date, the NHS has announced it is tendering a huge £700 million contract for providing NHS cancer care in Staffordshire and Stoke-on-Trent, along with another £500million for end of life care in the region.
It’s a dramatic indication of the rapidly increasing commercialisation and privatisation of the NHS.
In the messy fight over the Health & Social Care Act, during the ‘listening pause’ the Coalition promised parliament the changes they had made to the legislation included “ruling out any question of privatisation”.
How much more threadbare can that promise get?
This tender - the first on this scale - will cover cancer services for a population of over 1 million people. It has been labelled a ‘pioneer project’ and has major implications for the future of the NHS as a public service.
Hospital based frontline cancer services including surgery, chemotherapy and radiotherapy could be provided by the private sector.
According to trade press magazine, Health Service Journal, "the CCGs are considering a prime provider model. This would involve making a single organisation accountable for delivering the outcomes for an identified group of patients, such as those receiving care for a particular condition. This lead contractor would then subcontract NHS, private or voluntary sector providers to provide seamless care."
This "bundling" of contracts could undermine and fragment existing services within the cancer network.
There are already national shortages of professionals involved in cancer management. Contracts with non-NHS providers will take many of these highly trained staff away from the established NHS services, where the full range of cancer services are delivered to a regional population.
Private sector providers will only be interested in managing the high volume, low complexity work, leaving more complex and uncommon cancer care to the established NHS centres. The NHS will lose both government money and already scarce staff to the private sector.
Cancer services are highly complex and multidisciplinary. In my work as a clinical oncologist I treat patients with prostate and lung cancer. I work alongside surgeons, radiologists, pathologists, nurses, radiographers, medical physicists, palliative care specialists, physicians, and more.
The government has fundamentally misunderstood the complexity of cancer services, which evolve & develop over many years, but always with the flexibility to react to new developments cancer treatments. This needs careful planning at every level, from departmental to national. Subjecting the organisation of cancer services to a market driven tender is a reckless approach.
It is remarkable that the cancer charity MacMillan has got involved in this process to help guide the commissioning process. What impact could this have on the public reputation of MacMillan if it was seen to be involved in a tendering process that led to increasing privatisation of NHS services?
Polls show that less than one in five people thinks more compeition will improve NHS services. The public wants to keep the NHS as a public service and reject privatisation.
Of course, it may be that all of the contracts go to the established NHS providers in the region. Which would then rather raise the question, why did we waste taxpayers’ money on unnecessary transaction costs, which can easily run into the tens of millions?
And worringly, the project is being driven by the Strategic Project Team (SPT) - a shadowy part of NHS England with a history as “arch privatisers”. The SPT - consisting mostly of management consultants not permanent NHS employees - have been involved in most of the ‘ground-breaking’ NHS privatisations to date. It was they who outsourced Hinchingbroke, the first NHS hospital to be handed over to the private sector to run. Quite who they are accountable to is very unclear - like much in Cameron and Clegg’s NHS.
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