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Carnival of incompetence - or, how nobody knows how to privatise a health service well

Recent experiences show no-one knows how to privatise bits of the English Health Service without damaging the parts - like A&E - that are left behind. 

Image: 'Cherry picking', a key criticism of health 'reforms', is damaging services like A&E that private health companies don't want.

William Goldman, the famous Hollywood screenwriter once said about motion pictures that ‘nobody knows anything’ about whether a film will work. If Goldman had watched the calamitous privatisation of our NHS in recent months he’d have been struck by the similarity between the Hollywood studios and our embattled NHS.

Putting aside for a moment that privatisation is a fundamentally less effective way to run a public health service, nobody actually knows how to do privatisation.

If you were a government who wanted to pull to pieces our most treasured national institution, the most cost efficient health service in the world, without a democratic mandate, you’d at least want to do it well -, wouldn’t you?

In West Sussex, local health bosses decided last year that they need to open up MusculoSkeletal services (MSK) to competition.

I say ‘decided’ - such ‘local decisions’ start with central government, who handed £80bn to brand new health bosses (CCGs) with little experience of large-scale commissioning, then passed both law and policy that seemed to effectively force CCGs to open up all potentially profitable NHS services to private takeover bids sooner or later, or risk costly legal challenge if they didn’t. And it’s central government who have been imposing cuts at the same time, thus forcing the inexperienced CCGs to simultaneously restrict services.

Here in West Sussex, two organisations submitted bids to takeover MSK - the local NHS Trust already running the services, and BUPA Central Surrey Healthcare.

Bupa CSH won. Last September they signed a £235million contract for five years to run most of the MSK services in the region.

The problem was that BUPA CSH didn’t really know how this contract would impact other local NHS services - including A&E - because they were bidding against the only people who probably really knew this, the Trust themselves.

The local council’s Scrutiny Committee and the Trust who lost out, said this contract could destabilise other services, particularly A&E, by sucking money and staff time away from the latter. They called for a clear impact assessment to be carried out.

What the Government and CCG hadn’t thought about in their desire to allow BUPA CSH to cherry pick profitable health services is that multiple different health services are inextricably interlinked.

In fact to the extent they’d thought about it, they actually claimed that BUPA won the contract because the service it could offer was ‘more joined up’!

When all this was queried, the CCG  spent an awful lot of money to hire PriceWaterHouseCoopers to do an impact assessment to tell them what everyone else already knew. PWC found that the contract as it stood would negatively impact other services remaining in the trust and that the “cumulative impact of loss of MSK services” would result in the trust falling into financial deficit over the next five years.

The CCG didn’t have to pay PWC. It could have just looked over to Bedfordshire, who had already privatised MSK services (handed over to Circle) under the banner of ‘integration’. Bedfordshire had already found that such a deal DID in fact threaten the local hospital’s A&E services which is now becoming financially ‘unviable. Professor Tim Briggs, President of British Orthopaedic Association, called for a halt to new contracts while the impact of “bold experiments” like Bedfordshire’s MSK contract with Circle Healthcare is assessed thoroughly.

So what did the CCG do with this expensive, narrowly defined, but critical report? It declined to release it publicly, instead providing a brief summary (released at 2pm the day before Christmas eve).

This it considered the best course of action in face of mounting local concerns and thousands of signatures on a newspaper petition. The local Conservative MP, Tim Loughton, told everyone not to worry because he was having meetings, though his ministerial collegaues still obediently mouth the buzzwords of ‘inefficiencies’, ‘unviable’ and ‘aging population’.

Local councillors who are supposed to scrutinise decisions have allowed the CCG to tell them they can’t read the report til a couple of weeks before the contract transfers over to BUPA - surely too late to fix problems or even or halt the transfer if necessary.

Here in Sussex, BUPA CSH think they have isolated the cherries to pick but the PWC report, the cross-service nature of patient care for often unpredictable patients, and the fact that they couldn't do an adequate impact assessment because their competitor held necessary information, suggest they don’t have much of a clue either. Now they are bogged down in costly negotiations, mitigations and thousands of angry local people who don’t want them anywhere near their hospitals.

So where are we now? William Goldman could tell us. In essence nobody knows anything. Nobody knows how to privatise a national health service that nobody wants privatised.

History will not judge the political classes of 2010-2015 kindly. But it may at least spare us a sympathetic gaze if we vote them out of office.

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About the author

Dr Carl Walker leads a European Community Psychology Association Task Force on Austerity and Mental health and is a member of the National Health Action Party.


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