‘Richard Branson’s company becomes one of the first of many vultures to start picking over the rich, tender flesh of the NHS now that it has been splayed open by the (Health) Bill.’ So wrote pseudonymous Telegraph doctor Max Pemberton on the news that Virgin Care has won a £500?million contract to provide community services across Surrey and began running these services, as well as the county’s prison healthcare, on April 1.
When Telegraph columnists slate private healthcare provision, the government knows it has a problem but the groundwork for all this was done by Labour. In January 2009, it published Transforming community services: enabling new patterns of provision. ‘This guidance is intended to help PCT providers of community services to move their relationship with their commissioners to a purely contractual one and consider what type(s) of organisations would best meet the future needs of patients and local communities.’
The Health Bill cements and accelerates Labour’s vision of a competitive market for healthcare but may come a cropper if the public aren’t sufficiently involved in the decision making. Section 242 of the NHS Act 2006 makes clear that formal consultation is required in ‘instances in which the manner in which services are delivered, or the range of the services, will change.’ So the game is now on to hand services to the private sector while claiming they won’t change in order to avoid formal consultation with angry protestors who vehemently disagree with the giving large sums of public money and power to private companies and their share holders.
In September 2011, patient Michael Lloyd, 75, challenged the transfer of community services from NHS Gloucestershire Primary Care Trust to a private community interest company. His argument was that the PCT did not consult adequately on the proposals or give proper consideration to alternatives that would have seen the services remain within the NHS. The challenge went all the way to judicial review, with the PCT caving in on day 2 and agreeing to advertise for ‘expressions of interest for the provision of local services’ which may keep the service within the NHS. Or it may not.
Alas the judge did not clarify how EU procurement law will affect these NHS ‘outsourcing decisions’, but companies based in the EU and eyeing up the NHS market may have a legal right to be included in the tendering process, which would make it even harder, expensive and legally tortuous for the NHS to cling onto the provision of NHS services. As David Lock QC wrote in the Health Service Journal: ‘The duties of transparency, equal treatment and non-discrimination imposed by the EU treaty and the Public Contracts Regulations 2006 mean that all contracts placed with a body outside an NHS trust should be subject to a “degree of advertising” to allow healthcare providers located in another EU country the chance to bid for the contract.’
Despite this, a private hospital in Kent is already claiming it will offer the NHS and private patients ‘the only cardiothoracic and neurosurgery tertiary care beds in the county.’ The Clydesdale Bank last week agreed a £34m loan deal to help build and run the Kent Institute of Medicine and Surgery, which is due to open in the second quarter of 2014. Another £80 million will be provided by corporate and private investors, including around 100 clinicians.
Private provision in healthcare thrives when the NHS gives up trying (e.g. long term care of the elderly, psychiatry) and with so many hospitals and PCTs in huge debt, and the Department of Health facing a ‘significant’ accounts auditing problem, the choice for many NHS community and hospital services may soon be between private provision or nothing. And Labour started it all.