The NHS is being privatised bit by bit, and patients are
already suffering
Jacky Davis
Guardian, Monday June 27, 2005

Ill-equipped to compete in the increasingly cut-throat
healthcare market, the NHS is now £140m in the red. A
government that has done everything it can to expand the
role of the private sector in the NHS is unlikely to bail
hospitals out this time, and so this deficit will translate
into hundreds of lost beds, and ward closures up and down
the country.

This desperate situation forms the backdrop to the British
Medical Association's annual meeting, which begins in
earnest in Manchester today. This year's agenda contains
dozens of motions critical of the government's health
policies, and one of the first topics up for debate will be
privatisation. The government will be watching the outcome
closely. The Association of Surgeons of Great Britain and
Ireland has already come out strongly against private-sector
involvement in the NHS. If the BMA votes against it too, a
majority of medical opinion will have taken a stand against
the main health policy of Blair's third term.

The government has sought to present greater private sector
involvement in the health service as a means of creating
additional capacity, but already it is apparent that this is
not the real agenda. The private sector will not support the
NHS but compete with it, and NHS units and hospitals that
cannot compete will close. Independent sector treatment
centres (ISTCs) will be introduced whether patients want
them or not. Thus, when South Oxfordshire, Southampton and
Greater Manchester primary care trusts declined to place any
contracts with the private sector, they were ordered to do
so, even though they had no waiting lists in the specialties
the private sector wanted to service. And when too few
patients agreed to be treated at ISTCs in Trent and South
Yorkshire, the PCT paid for "care advisers" to persuade them
to change their minds. Patient choice comes a poor second to
government policy.

ISTCs are paid on average 40% more than NHS providers. They
are often guaranteed five- or 10-year contracts. They have
no requirement to teach and train and they do not provide
expensive emergency and high-dependency care. They mop up
"easy" cases, leaving the difficult and more costly ones to
the NHS. This has skewed the case-mix seen by the NHS and is
affecting training in some specialties. And because fewer of
the low-risk cases are being seen in NHS hospitals, young
surgeons are no longer getting the training they need.

ISTCs have little responsibility for follow-up, and many
cannot cope with complications. In some areas they are
refusing to carry out procedures on up to 65% of the cases
referred to them because they do not have the technological
resources.

Standards are also an issue. Alliance Medical, with a
five-year contract to provide £95m worth of MRI scans, was
unable to register with the Healthcare Commission and as a
consequence is not subject to NHS standards. Lewisham
University Hospital cancelled referrals to its mobile MRI
unit because of concerns about quality. It has since become
apparent that scans were being sent abroad to be read,
without any apparent clinical governance safeguards.
Meanwhile, NHS hospital scanners remain idle for lack of
funding.

Radiology is not the only area of concern. Dinesh Verma,
medical director of Netcare Ophthalmology Chain UK, resigned
over patient safety concerns in mobile surgical treatment
centres. Netcare, which has a five-year contract to provide
40,000 operations, was failing to ensure proper continuity
of care and on-call cover.

Labour's professed desire for additional capacity sits oddly
with its record on NHS beds. Since taking office it has
closed 12,000, and the policy of favouring ISTCs has meant
that closures are continuing at a dramatic pace. As Nigel
Edwards,director of the NHS Confederation, has warned: "The
removal of large amounts of elective work from existing
hospitals can threaten the viability of the services that
remain."

John Denham, the former Labour health minister, has echoed
his concerns, highlighting the risk of "perverse outcomes
... if operations in private hospitals cost more than in NHS
hospitals and the latter are closing their wards". As a
result of budget deficits, hundreds of bed losses have been
announced this month: 90 in West Hertfordshire; 200 in
Leeds; 30 from the brand new PFI hospital, Queen Elizabeth
Woolwich; ward closures in Kings Lynn ... the list goes on.

Of course, the government has an answer to all NHS objectors
to the private sector. Government expenditure on the NHS is
projected to rise from 7.7% of GDP in 2003 to 9.2% in 2008,
or an extra £20bn a year by 2008 in real terms compared with
2004.

This largesse has allowed the government to portray itself
as a friend of the NHS. The consequence is that there is
less a debate than a stand-off between two compelling yet
seemingly paradoxical propositions: "The government is
rebuilding the NHS through an unprecedented expansion in
funding" versus "the government is destroying the NHS
through an unprecedented process of marketisation,
privatisation and commercialisation".

A gainst this background, it is significant that the last
time there was a comparable increase in spending on the NHS,
in 1991, the extra money went to pay for the costs of the
internal market. Once again, much of the new spending is
going to meet the costs involved in bringing in the private
sector. Major additional transaction costs are involved, as
they were in 1991. Money that should be spent on frontline
care will be diverted to making and monitoring hundreds of
thousands of contracts, billing for every treatment (to
achieve "payment by results"), and paying for accounting,
auditing, legal services and advertising - not to mention
shareholders' profits.

The NHS chief executive, Nigel Crisp, has said that
foundation trusts "should adopt the same marketing
techniques as Tesco in their bids to win customers in the
new choice-based NHS market". A special marketing advice
agency, the Insight Unit, has been set up in the Department
of Health to give marketing advice, and plenty of companies
are moving in to help trusts "profile" health "consumers".
Hospitals will advertise for patients.

In 1997 the Labour party denounced PFI as creeping
privatisation. They asked senior doctors to sign a letter in
which they described the internal market as a cancer eating
away at the NHS. Doctors agreed and voted for them, and now
we feel betrayed. We see hospitals closing wards and
operating theatres. We see huge profits already going to PFI
companies. We are not deceived by the rhetoric about patient
choice and predict that patients may lose the one choice
that is important - a good comprehensive local hospital.

In a system where, as a CEO recently told his managers,
every part of the business must generate a surplus, patients
will come second to profits. When the dictates of the market
replace the public service ethos patients will suffer. If
the government does not heed the doctors' warnings, the
cancer they correctly diagnosed eight years ago will destroy
the NHS.

Dr Jacky Davis is a consultant radiologist in London and a
member of the National Health Service Consultants' Association

 [log in to unmask]
-------------------
Problems/Questions? Send it to Listserv owner: [log in to unmask]


To unsubscribe, send the following message in the text section -- NOT the subject header --  to [log in to unmask]
SIGNOFF SDOH

DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU.

To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header.
SUBSCRIBE SDOH yourfirstname yourlastname

To post a message to all 1000+ subscribers, send it to [log in to unmask]
Include in the Subject, its content, and location and date, if relevant.

For a list of SDOH members, send a request to [log in to unmask]

To receive messages only once a day, send the following message to [log in to unmask]
SET SDOH DIGEST

To view the SDOH archives, go to: https://listserv.yorku.ca/archives/sdoh.html