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New figures published by the NHS support Federation this week prove that the government’s NHS changes are resulting in increased outsourcing. Nearly 200 contracts, worth £2.5billion in total, have been offered since April. The surge in tenders is one of the first signs that the government’s rules on competition are opening up more of the NHS to the market.
The biggest contract so far is worth over a billion pounds and is to provide community services in Cambridgeshire. Seven other areas have similar contracts in the pipeline. The contracts will attract interest from the big corporate players like Serco and Virgin, who have both already scooped up sizable deals in this area.
Those opposed to NHS “markets” worry that the NHS just cannot compete effectively for contracts against private providers.
Our figures bear out the reality of these fears. Out of the twenty four clinical contracts that have been awarded since April only 4 have gone to the NHS. If the trends continue, huge levels of outsourcing are certain. This is the mechanism by which our health service will gradually be privatized.
The NHS has involved the private and charitable sector for years. Privatisation started in the eighties with mental health and long term care. Labour invited companies to help out with surgery to cut waiting lists and encouraged their costly involvement through PFI and the setting up of a network of health centres.
But these moves are dwarfed by the scope of treatments and care now open to commercial providers.
In today’s NHS, private companies are providing everything from maternity to end of life care.
In this market driven era, and with the NHS under pressure, commissioners are finding it difficult if not impossible to invest in the NHS and respond to the changing needs of patients, without giving the private sector the opportunity to bid.
In Wiltshire a £63 million contract is out for tender to provide community maternity care.
Thirty contracts for diagnostic testing have appeared since April alone, particularly for pathology and imaging. Together with home care and mental health contracts these account for a third of all current contract opportunities across the country.
Despite the huge controversy around the performance of Serco and Harmoni who have been accused of providing patients with poor or “unsafe” services, ten further GP Out of Hours tenders are underway.
Ambulance contracts too are up for grabs, covering both non-emergency transportation and the care of the sickest through blue light services. One such contract has just been awarded in Exeter where £50million will be divided between several private companies.
And whole NHS hospitals are being turned over to private companies. Following in the footsteps of Hinchingbroke (entirely run by a private company Circle) is George Elliot in Nuneaton. Like other NHS hospitals it is struggling financially and looking for a private partner.
It is perfectly conceivable that every step of your journey as a patient, from the first visit to your GP, through diagnosis and tests, consultation, surgery and then after-care at home could all now be managed by private companies.
It is a sign of how far the privatization project has come that a patient could receive whole packages of complex care and never meet a member of NHS staff. For most patients this is still not the reality, but it is an imminent risk if the NHS continues to be squeezed out of business and forced to take its contracts to the market.
In fact the pressure from commercial competition started before the Act had even been passed. Back in 2012 the government told local NHS bodies to invite providers to compete to provide a whole range of community services – under the renamed Any Qualified Provider scheme. Thirty-nine treatments were put forward. Podiatry, hearing and physiotherapy were the most common areas where private providers were invited to compete with the NHS.
It was this that allowed Specsavers to start providing high street hearing tests to thousands of NHS patients. They have been criticised for aggressive marketing tactics and poaching patients from the NHS. For Specsavers, this is good business. It’s just not the way the NHS should be doing business.
Faced with competition and falling income the NHS is left with the bizarre choice to spend more on marketing of its own or move out of this area and leave it to the privateers to fight it out.
Our evidence bears out the predictions of many commentators on how the Act would accelerate privatisation.
But our information on contracts does not come from the Department of Health, who apparently don’t collect it. Nor can you find it by asking questions in Parliament. Instead, providing information that should be readily available to the public, requires a painstaking process of picking through impenetrable websites and gathering research to provide information. As a campaign we want to play our part in getting the truth out there. But it is shocking that the government fails to answer simple questions about how public money is being spent.
As the market machine within the NHS revs dangerously into life, it is vital to keep collecting and sharing information about the impact. Its progress is not straightforward. I for one remain hopeful that it can be stopped.