NHS services to be opened up to competition

More than £1bn of NHS services are to be opened to competition from private companies and charities, including wheelchair services for children, writes Randeep Ramesh in the Guardian

The government will open up more than £1bn of NHS services to competition from private companies and charities, the health secretary announced today, increasing fears that it will inevitably lead to the “privatisation of the health service”. In the first wave, beginning next April, eight NHS areas – including musculo-skeletal services for back pain, adult hearing services in the community, wheelchair services for children and primary care psychological therapies for adults – will be open for “competition on quality not price”.

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If successful, the policy, known as “any qualified provider”, would see non-NHS bodies allowed from 2013 to deliver more complicated clinical services in maternity and “home chemotherapy”. Admitting that the government’s initial plans for competition in the NHS were too ambitious – and stung by criticism by Steve Field, the senior doctor called in by David Cameron to review the government’s reforms, that the proposals were “unworkable”, Andrew Lansley has slowed down the roll-out of competition in the health service.

The health secretary said his plans would now “enable patients to choose [providers] … where this will lead to better care”. Critics, however, warned of “huge dangers lurking in the plans”. The trade union Unison said that “patients will be little more than consumers, as the NHS becomes a market-driven service, with profits first and patients second. And they could be left without the services they need as forward planning in the NHS becomes impossible.”

A spokesman for the British Medical Association questioned “the assumption that increasing competition will always mean improving choice. The ultimate consequence of market failure in the NHS is the closure of services, restricting the choice of patients who would have wished to use them.”

Officials in the Department of Health dismissed these charges. One senior civil servant said the policy would benefit patients by bringing many services out of hospital – which would make it easier to access healthcare. “It is a pain to turn up for hospital and wait for 45 minutes for a blood test. Far better that you could walk into a local Boots or Lloyds chemist or a local health centre and get it done.”

The civil servant, who briefed on the condition of anonymity, also said that the new policy would promote innovation – highlighting the “Tony Blair example”. He pointed out that the former prime minister’s abnormal heart rhythms could today be treated by using the telephone to measure the heart beats and give an instant diagnosis, followed by a call from a nurse advising on whether the patient needed to “go to hospital or not”. “You could cut dramatically the number of hospital admissions like this.”

He also pointed out that major savings could be made, citing the example of chronic leg wounds, where the NHS pays out £18,000 per patient over four years, often without curing them. One not-for-profit company – Wound Healing Centre in Sussex – manages to treat patients successfully for £720.

To underline the commitment to the new policy, Lansley’s commissioning tsar, Dame Barbara Hakin, said the NHS must push ahead with the agenda to offer patients more choice despite the financial challenges and the period of “significant transition”. The NHS has to save £20bn over the next four years in efficiencies.

Labour disputed the gains, saying the policy was just a step towards privatisation. John Healey, the shadow health secretary, said: “The Tory-led government is pushing ahead with its wasteful and unnecessary NHS reorganisation, rather than focusing on improving patient care. David Cameron’s plans for the NHS are not about giving more control to patients, but setting up a full-scale market.”

The Guardian

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