How they’re sneaking the NHS into private hands
It is difficult to avoid the conclusion that unless something is done the NHS will fall prey to a profit-driven, market-based, collection of competing enterprises, argues professor Harry Keen
Confuse & Conceal: The NHS and Independent Sector Treatment Centres.
By Stewart Player and Colin Leys.
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CONFUSE and Conceal is a clear exposition of what is happening to the NHS.
It argues that independent (that is, private) sector treatment centres (ISTCs), are a major step towards reversing the Labour Party’s 1997 manifesto pledge to “restore the NHS as a public service… not a commercial business driven by competition”.
In opposition, Labour had vowed to abolish the NHS market, fiercely opposed the private finance initiative (PFI) and made clear that, whatever happened to car parks and hospital laundries, clinical services would always be sacrosanct.
But since its return to power it has advanced NHS marketisation to a point Margaret Thatcher would never have dared.
Confuse and Conceal aptly describes how this is being done with so little public outcry.
It presents the ISTC programme in the context of a broader design to incorporate the NHS into the market economy.
The ISTC programme comes in two phases. The first, started in 2002, commissioned private companies to set up units, mainly to carry out surgical procedures to cut hospital waiting lists. By early 2007 all of the many privately run ISTCs, were now confusingly allowed to call themselves NHS treatment centres.
The second phase, launched in 2005 but still gathering pace, is largely to appoint ISTCs to provide primary care and diagnostic services.
Because there is a more direct public involvement in these, they are harder to conceal and, in many cases, they have been challenged by the public and professionals.
The contracts themselves – involving £5.6 billion of taxpayers’ money – are protected by commercial confidentiality and thus inaccessible even to the House of Commons Health Committee, set up to review the performance of ISTCs.
Despite this the authors outline some of the alluring terms, guarantees and risk protections enjoyed by the successful bidding companies.
Clauses to preclude the employment of NHS staff were violated in phase 1 and virtually abandoned in phase 2. ISTCs can now be more clearly seen to be replacing rather than reinforcing the NHS.
The House of Commons committee’s reaction to its enquiries being hindered have been surprisingly muted.
It failed to identify the full purposes of the programme – just how far it was meant to destabilise the existing NHS and open the way for what Patricia Hewitt, then health secretary, described as the potentially unlimited expansion of private sector activity within it.
It concluded that much of the work done in the first phase was not additional work but procedures that could well have been carried out in NHS trusts.
Information on the numbers of first phase procedures were hard for the authors to come by; much of what they did get was squeezed out by Freedom of Information requests.
The authors conclude that the figures supplied to the Health Committee and Health Commission by the Department of Health seriously overstated the performance of ISTCs.
That poor performance occurred notwithstanding measures to divert patients from sound NHS establishments into flagging ISTCs, and substantial cash offered to GPs to refer patients to ISTCs rather than NHS units.
And despite ISTCs’ performance being hyped, the health committee concluded that the programme had little, if any, influence on cutting waiting times.
The ISTC programme is still small but other current changes, such as the new consultant contract with its consultant chambers and “fee for service”, exemplify the so-called “new market realities”.
So, too, may the shift of diagnostic and therapeutic activity from hospital into a new, refurbished, community configuration, the Ara Darzi vision, which can be represented as a potentially marketable investment prospect.
Privatised primary care will doubtless be sold to a dubious public as PFI was – a quick way to build now, pay later.
This market-driven alternative will maintain the brand name, livery and social image of the NHS but little else.
At the heart of the ISTC programme is what the authors describe as “an inner cadre of people with shared ideas and inside knowledge” surrounded by a growing circle of health policy theoreticians, management gurus, company executives, perhaps even a few health professionals.
We find some familiar names among them.
They are the NHS National Leadership Network (NLN).
The NLN is intended, we learn, to “provide collective leadership for the next phase of transformation… and promote shared values and behaviours”.
No doubt full of entrepreneurial initiatives, this NLN, but transparency, public contestability and democratic accountability appear not to be among them.
And what is the impact of the Gordon Brown succession on a policy very much identified with Tony Blair?
Hints that the appetite for privatisation is waning are dismissed as illusory, masking what may in fact be an intensification of the process.
Some will doubtless dismiss Confuse and Conceal as an ingeniously constructed ideological delusion.
Others will be stimulated to redouble their efforts to protect the NHS from growing commercialisation.
It is difficult to avoid the conclusion that unless something is done, this great social enterprise, the NHS, will fall prey to a profit-driven, market-based, collection of competing enterprises.
Anyone who has concern for the future of the NHS will gain in their understanding from this book. Clear and direct, it should alert many of the current threats to its future and persuade them to add their voices to the rising warning chorus.