The Guardian with Kailash Chand take a strong position about the NHS: “The notion that competition promotes excellence and market forces breed efficiency is a myth”
(The Guardian, Kailash Chand) – Last year, a majority of new contracts to provide NHS services went to private companies. Most of these private companies hide behind the NHS logo but siphon off a profit. Collectively, such providers received more than £10bn from the public coffers in 2013. And according to the Financial Times, around £5.8bn of NHS work is currently being advertised to the private sector, a 14% increase on a year earlier.
Clinical commissioning group (CCG) leaders do not consider that privatisation is their main agenda. They do admit, however, that they face difficult decisions regarding the need to tender which, in a nutshell, is a tool for commissioners to facilitate competition. Promoters of the concept of Any Qualified Provider who indulge in marketisation do so under the false belief that this achieves better health outcomes, which flies in the face of both the theory as well as overwhelming evidence that equity, efficiency and equilibrium of the NHS are adversely affected.
For the last two decades, the leaders of all major political parties have been wedded to the concept of the marketisation of healthcare. Do they seriously believe that private healthcare companies would not put profits before patients? The idea that competition breeds excellence and market forces drive efficiency is a myth. There is not an iota of evidence that the costs go down and efficiency improves when private companies deliver NHS care. Costs increase and services may well get worse. Already we have seen major companies such as Serco criticised for failing to report accurately on their performance. An NHS contract for elective services with the private company Clinicenta was terminated due to poor quality care. It was bought out at great expense to the taxpayer and taken back in-house by the NHS. The commissioning system makes it easy for private providers to cherry-pick tasks to ensure they maximise their income and overall profit from the NHS while minimising their costs. It must be largely paid for by some kind of central taxation like the NHS, or an insurance scheme like in the US and other developed countries. This means that someone other than the patient ends up making decisions about what is affordable.
In my view competition is nonsense when it comes to healthcare, and choice is an illusion; delivering them on the back of commissioning private providers is hoodwinking the British public. These are businesses that are run for shareholders and they work on the basis of profit margins firstly, and then promotion of health. From the perspective of patients and taxpayers this bias is undesirable – a recipe for overcharging, over-treatment and corner-cutting on safety. There are no evidence-based examples of successful healthcare relying on the principles of the free market. Already, patients are being denied prompt hip or cataract operations – and the list of hard-to-get services will increase, reducing the NHS to a skeleton. Money that could be spent on patient care is being spent on unnecessary bureaucracy, management consultants, tender procurement, debt interest and dividends.
We must surely take pride in the free access we have to one of the best health systems in the world, regardless of age, social status, ethnic background or beliefs. This is our NHS – from cradle to grave. We own it and we pay for it, but it is being ripped from the hands that have carefully cherished it for decades and is gradually being placed in the grasping claws of profit driven, private providers. And in this sort of health service the chronically and terminally ill, people with mental health problems, those from lower socio-economic groups and older people are likely to lose out. High-quality commissioning is essential to improve the standard of health services available to patients and ensuring the best possible use of limited NHS resources. This is best undertaken by clinicians from primary and secondary care working with patients who respect the values and ethos of the NHS.
Do we really want an NHS that is obsessed with private companies tendering for the work? Or do we want a health service that is passionate about caring for the seriously ill and vulnerable? It doesn’t have the ability to do both, and given its roots and origin, the Health and Social Care Act has created a schism that is causing turmoil.